GESTATIONAL DIABETES AND INSULIN NEEDS DURING GESTATION

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 806-823-Gestational Diabetes
Basic/Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-815
Sandra Belo*1, Angela Magalhães2, Cristina Gamboa3, Joana Queiros4 and Davide Carvalho5
1Faculdade de Medicina da Universidade do Porto, 2Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar de São João, 3Serviço de Obstetrícia, Centro Hospitalar de São João, 4Hosp Sao Joao-Oporto Med Schl, Oporto, Portugal, 5São João Hospital, Faculty of Medicine, University of Porto, Portugal, Portugal
Background:Pregnancy is characterized, especially after de first trimester, for a state of insulin resistance. It is well known that insulin needs increase during pregnancy being higher in the third trimester.

Aim:To evaluate the insulin needs in each trimester of pregnancy and the relative needs of basal and prandial insulin.

Methods:This study included women diagnosed with GD between 2011 and the first quarter of 2012. Diagnosis was made according to IADPSG criteria. Data related to anthropometric and therapeutic parameters, in each trimester (T) and at the end of pregnancy, were collected.

Results: There were included 176 women with GD, only 113 with information regarding insulin dose at all trimesters. Mean age at the beginning of the follow-up was 32.1±5.4 years. Gestational diabetes diagnosis was made by fasting glycemia in 51.3% of the patients (at 9.6±4.8 weeks) and after OGTT in 45.1% of the cases (at 24.7±3.7 weeks). Glycemic control was achieved only with diet planning in 31.0% of the cases; treatment with insulin was needed in 61.1% of the patients. Insulin therapy was begun at 26.5±7.3 weeks (at 22.7±7.1 weeks when the diagnosis was made in the 1st T and at 30.3±4.6 weeks when the diagnosis was made in the 2nd T; p<0,001).  The initial insulin dose (ID) was 8.2±11.4UI in 2±1 administrations, 36.6% of the patients begun only intermediate-acting insulin (5.1±3.1UI), 28.2% only with fast-acting analogs (4.1±2.1UI) and in 35.2% of the cases with both (intermediate-acting 15.4±17.2UI; fast-acting analogs 7.1±3.8UI).  At the end of gestation the mean ID was 34.0±27.7UI with 4±2 administrations. We observed that 19.5% of the patients initiated insulin in the 1st T, 15.0% in the 2nd T, 13.3% between the 2nd and the 3rd T, 9.7% in the 3rd T and 6.2% in the last weeks of gestation. In those patients who initiated insulin in the 1st T a variation of 3.3% in ID to the 2nd T was observed (7.3±5.8 vs 23.7±15.5UI), of 1.6% from the 2nd and the 3rd (23.7±15.5 vs 38.4±20.5UI) and a variation of 1.2% from the 3rd to the end of pregnancy (38.4±20.5 vs 46.8±31.3UI). Similar results were found in the patients who begun insulin in the 2ndtrimester. We also found that patients with GD presented significantly higher needs of fast-acting insulin.

Discussion: Insulin needs increase progressively during pregnancy. Globally there is a higher requirement for fast-acting insulin.

Nothing to Disclose: SB, AM, CG, JQ, DC

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm