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Hypoglycemia Risk Reduced With Pre-Pregnancy Insulin Therapy

Women with type 1 diabetes treated with prandial insulin aspart prior to pregnancy have lowest risk

MONDAY, March 22 (HealthDay News) -- Treating women with type 1 diabetes with the insulin analog prandial insulin aspart (IAsp) prior to their becoming pregnant reduces the risk of severe hypoglycemia at every stage of pregnancy, according to a study in the March issue of Diabetes Care.

Simon Heller, M.D., of Northern General Hospital in Sheffield, U.K., and colleagues administered either IAsp or human insulin to 99 women with diabetes who were not yet pregnant and to 223 women with diabetes who were pregnant fewer than 10 weeks. The researchers monitored the women for the development of severe hypoglycemia prior to conception, during pregnancy and after delivery, and evaluated risks at each stage.

Overall, the researchers found that 23 percent of the women suffered severe hypoglycemia during pregnancy with the peak occurring in early pregnancy. Severe hypoglycemia incidence (expressed in episodes per patient per year) was lower in the women treated preconception than the women treated in early pregnancy: 1.7 versus 3.4 in the first half of pregnancy, 0.8 versus 0.9 in the second half of pregnancy, and 1.5 versus 2.1 postpartum. Furthermore, among the women treated preconception, severe hypoglycemia rates were lower for IAsp than human insulin at all stages: prior to conception, 0.9 versus 2.4; in the first half of pregnancy, 0.9 versus 2.4; in the second half of pregnancy, 0.3 versus 1.2; and post partum, 0.2 versus 2.2.

"These data suggest that initiation of insulin analog treatment preconception rather than during early pregnancy may result in a lower risk of severe hypoglycemia in women with type 1 diabetes," the authors write.

Two study authors are employees and shareholders of Novo Nordisk, and another has received research funds, served on advisory boards, and been a speaker for the company.

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