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Therapeutics/Prevention
Randomized clinical trial
Detemir is non-inferior to NPH insulin in women with pregestational type 2 diabetes and gestational diabetes mellitus
  1. Priyathama Vellanki,
  2. Guillermo Umpierrez
  1. Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to : Dr Guillermo Umpierrez, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, 49 Jesse Hill Jr. Dr. SE, Atlanta, GA 30308, USA; geumpie{at}emory.edu

http://dx.doi.org/10.1136/ebmed-2015-110309

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    Commentary on: Herrera KM, Rosenn BM, Foroutan J, et al. Randomized controlled trial of insulin detemir versus NPH for the treatment of pregnant women with diabetes. Am J Obstet Gynecol 2015;213:426.e1–7.OpenUrlCrossRef

    Context

    Pregestational diabetes (pre-GDM) and gestational diabetes mellitus (GDM) affect as many as 1.3% and 9.2% of pregnancies, respectively.1 ,2 Hyperglycaemia during pregnancy has been associated with a two to three times increased risk of congenital defects and with the rate of macrosomia and stillbirth in the fetus and preeclampsia in the mother compared with pregnancies in a non-diabetic population.3 The risk of maternal and fetal complications is closely related to poor glycemic control, in particular postprandial hyperglycaemia.3 Current guidelines recommend intensification of glycemic control for at least 3 months before pregnancy in women with type 1 and type 2 diabetes.3 To achieve these goals, most patients are treated with multidose insulin injections with a combination of basal and prandial …

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    Footnotes

    • Contributors GU and PV reviewed the literature and wrote the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.