Comparison of Efficacy Between Short Acting Insulin & Rapid Acting Insulin in Controlling Blood Glucose Level Among Newly Detected Diabetic Disorder in Pregnancy

Background: Hyperglycemic disorders during pregnancy, including gestational diabetes mellitus (GDM) and diabetes in pregnancy (DIP) are increasing worldwide with the adoption of updated diagnostic criteria. These disorders are associated with adverse maternal, fetal and neonatal outcomes; however, optimal glycemic control can significantly reduce complications. Postprandial glucose regulation is a critical component of management. Rapid-acting insulin analogues, such as insulin aspart may provide improved postprandial glucose control with a lower risk of hypoglycemia compared with regular insulin. This study aimed to compare the short-term efficacy and safety of insulin aspart versus regular insulin in pregnant women with hyperglycemic disorders.

Methods: A randomized controlled trial was conducted among 79 pregnant women with GDM or DIP at the Feto-maternal Medicine OPD and IPD, Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, from January to December 2023. Participants were randomly assigned to receive either regular
insulin (n=39) or insulin aspart (n=40) after failure of medical nutrition therapy. Blood glucose levels and hypoglycemic episodes were monitored for two weeks.

Result: Total 79 respondents were included in this study. The study showed mean postprandial blood glucose levels were significantly controlled (81.6%) with Rapid acting insulin, Insulin Aspart in comparison to regular insulin (58.3%) with p-value: 0.029 when assessed after two weeks of treatment. In control group 38.9% experienced level 1 and 5.5% experienced level 2 hypoglycemia. On the contrary 15.8% and 2.6% of rapid acting insulin developed level 1 and level 2 hypoglycemia respectively. So, the proportion of hypoglycemia was significantly higher in control group with Regular insulin. But none of the two group showed any level 3 hypoglycemia. Time required for controlling blood sugar also less (mean for control group 212.57±59.89 versus mean for experimental group 173.41±72.85 in hours). Regarding insulin dose control group required significantly higher dose (25.63±15.5 versus 15.67±8.44) of insulin(p-value:0.003).

Conclusion: The result of this study demonstrated that effective postprandial glycemic control in women with hyperglycemic disorder in pregnancy can be brought about by Rapid insulin, Insulin Aspart with shorter duration and less chance of hypoglycemia.

Keywords: GDM, DIP, Regular Insulin, Rapid Acting Insulin, Insulin Aspart, Efficacy.