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Cited by 16Gestational Diabetes Research and ManagementDiabetes Management and ResearchHyperglycemia and glycemic control in critically ill and hospitalized patients

Efficacy and safety of the pregnancy‐IVI, an intravenous insulin protocol for pregnancy, following antenatal betamethasone in type 1 and type 2 diabetes

Rowe, Christopher W., Watkins, Brendan, Brown, Karina, Delbridge, Matthew, Addley, Jordan, Woods, Andrew, Wynne, Katie·2021·Diabetic Medicine
DOI 10.1111/dme.14489
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Abstract

Aims: Hyperglycaemia following antenatal corticosteroids is common in women with diabetes in pregnancy, and validated algorithms to maintain pregnancy‐specific glucose targets are lacking. The Pregnancy‐IVI, an intravenous‐insulin (IVI) algorithm, has been validated in gestational diabetes; however, its performance in pre‐existing diabetes (Type 1 and Type 2 diabetes) is not known. We hypothesised that Pregnancy‐IVI would be superior to a generic Adult‐IVI protocol (prior standard of care) following betamethasone in women with pre‐existing diabetes. Methods: A retrospective cohort study enrolled all women with pre‐existing diabetes at a tertiary centre receiving betamethasone and treated with IVI according to one of two protocols: Adult‐IVI (n = 73, 2014–2017) or Pregnancy‐IVI (n = 62, 2017–2020). The primary outcome was on‐IVI glycaemic time‐in‐range (capillary blood glucose (BGL) 3.8–7.0 mmol/L). Secondary outcomes included time with critical hyperglycaemia (BGL > 10 mmol/L); occurrence of maternal hypoglycaemia (BGL < 3.8 mmol/l) and incidence of neonatal hypoglycaemia (BGL ≤ 2.5 mmol/L). Analysis was stratified by diabetes type. Results: Overall, Pregnancy‐IVI achieved a higher proportion of on‐IVI time‐in‐range (70%, IQR 56–78%) compared to Adult‐IVI (52%, IQR 41–69%, p < 0.0001). The duration of critical hyperglycaemia with Pregnancy‐IVI was also reduced (2% [IQR 0–7] vs 8% [IQR 4–17], p < 0.0001), without an increase in hypoglycaemia. Glycaemic variability was significantly reduced with Pregnancy‐IVI. No difference in the rate of neonatal hypoglycaemia was observed. The Pregnancy‐IVI was most effective in women with Type 1 diabetes. Conclusion: The Pregnancy‐IVI algorithm is safe and effective when used following betamethasone in type 1 diabetes in pregnancy. Further study of women with type 2 diabetes is required.

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Authors
Rowe, C. W., Watkins, B., Brown, K., Delbridge, M., Addley, J., Woods, A., & Wynne, K.
Affiliations
  • John Hunter Hospital (AU)
  • University of Newcastle Australia (AU)
Corresponding author
Rowe, Christopher W.
ORCID
Venue
Diabetic Medicine
Publisher
Wiley
Published
2020-12-15
Volume
38
Issue
4
Pages
e14489-e14489
ISSN
  • 0742-3071 (ISSN-L)
  • 1464-5491
DOI
10.1111/dme.14489
OpenAlex
W3108284085
Cited by
16
References
27
Citations by year
2026: 1 · 2025: 3 · 2024: 2 · 2023: 4 · 2022: 4 · 2021: 1
FWCI
1.38
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Diabetic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion)
  • RUNE (Research UNE) (submittedVersion)
  • NOVA (University of Newcastle Australia) (submittedVersion)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Keywords
antenatal betamethasone, pregestational diabetes, type 1 diabetes, type 2 diabetes, hyperglycemia, time in range, neonatal hypoglycemia, insulin dosing algorithms, gestational diabetes mellitus, antenatal corticosteroids, glycemic variability
MeSH terms
Glycemic Control, Adult, Algorithms, Australia, Betamethasone, Blood Glucose, Clinical Protocols, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Hospitalization, Humans, Infant, Newborn, Insulin, Pregnancy, Pregnancy in Diabetics, Prenatal Care, Retrospective Studies, Cohort Studies, Treatment Outcome, Administration, Intravenous

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