A Diabetes Management Protocol with Subcutaneous Insulin During Induced Labor and Delivery in Women with Type 1 or Type 2 Diabetes

AIMS/HYPOTHESIS: To evaluate a diabetes management protocol with subcutaneous insulin during induction of labor and delivery in women with type 1 diabetes (T1D) and insulin-treated type 2 diabetes (T2D). MATERIAL AND METHODS: A secondary analysis of the CopenFast trial, including women undergoing induction of labor. According to the diabetes management protocol, usual diet and insulin were initially continued. From the onset of active labor, target glucose was 4.0-7.0 mmol/L, and intravenous glucose infusion (3 g/h) was given. Women using multiple daily injections discontinued routine insulin injections, and nonautomated insulin pump users continued subcutaneous basal insulin via the pump. Supplemental insulin was given if glucose levels exceeded target levels. Continuous glucose monitoring was used in T1D and hourly capillary blood glucose monitoring (BGM) with a glucometer in T2D. Study endpoints were maternal glucose control and neonatal outcomes. RESULTS: In total, 113 women (85 T1D and 28 T2D) were included. HbA1c was 42 ± 5 and 41 ± 10 mmol/mol (6.0 ± 2.0% and 5.9 ± 2.0%) [mean ± standard deviation (SD)]) at 35 weeks. Glucose infusion was given for 4.8 (2.0-7.0) and 5.5 (4.0-8.0) (median [interquartile range (IQR)]) hours. During induction and active labor, mean sensor glucose in T1D was 5.9 ± 1.8 and 7.1 ± 1.8 mmol/L (106 ± 32 and 128 ± 32 mg/dL), respectively, and mean BGM in T2D was 5.6 ± 2.8 and 5.8 ± 1.2 mmol/L (101 ± 50 and 104 ± 22 mg/dL). During active labor, maternal hypoglycemia (≤3.9 mmol/L [70 mg/dL]) occurred in 6% and 11%. Supplemental insulin was administered in 35% (4.0 IU [2.0-7.5]) and 18% (2.0 IU [2.0-4.0]). Neonatal hypoglycemia (<2.2 mmol/L [40 mg/dL]) occurred in 12% and 4%. CONCLUSIONS/INTERPRETATION: Following a diabetes management protocol with subcutaneous insulin during induction and active labor, glucose control was close to target, with low prevalence of maternal and neonatal hypoglycemia. These findings support the feasibility of subcutaneous insulin during labor and delivery.