A standardized protocol for continuous subcutaneous insulin infusion in the peripartum period in women with type 1 diabetes

Objectives and methods. Metabolic control must be optimized to prevent maternal-neonatal complications during and after delivery. The primary aim of this study was to provide a standardized protocol for continuous subcutaneous insulin infusion (CSII), with or without real-time continuous glucose monitoring (RT-CGM), during delivery in pregnant type 1 diabetic women. This procedure was based on a retrospective multicenter observational study in which CSII was used around the time of delivery by women already instructed on its use during pregnancy. Three basal insulin rates were established, depending on the capillary blood glucose level (CBG): profile A, last basal rate in use before delivery; profile B, half of profile A; profile C, 0.1-0.2 U/h, for CBG < 70 mg/dl, activated just before anesthesia or at the beginning of active labor. An alternative intravenous insulin protocol (IVP) was applied in case of complications or sudden metabolic deterioration. Primary outcomes were CBG in the target range (70-140 mg/dl) throughout delivery and the percentages of women managed with the IVP. Results. The study comprised 65 pregnant women with diabetes: 56 (86%) had cesarean section, 9 (14%) spontaneous/ induced vaginal delivery. Mean CBG was 102 ± 31 mg/dl at time 0; 109 ± 42 mg/dl at 30 min; 120 ± 48 mg/dl at 60 min; 99 ± 34 mg/dl at 24 h. Mean basal rate during delivery was 0.6 ± 0.4 U/h (profile B). Mean CBG was lower in the RT-CGM group than with CSII alone: 80 ± 14 mg/dl vs 111 ± 32 mg/dl at 0 min (p < 0.01); 79 ± 11 mg/dl vs 109 ± 42 mg/dl at 30 min (p < 0.02); 98 ± 20 mg/dl vs 125 ± 51 mg/dl at 60 min (p = ns). There were 11 cases (17%) of neonatal hypoglycemia, 9 of them transient. No women had to switch to IVP. No major differences were observed in relation to the delivery procedure. Conclusions. CSII is feasible and safe during delivery in selected women who have been appropriately instructed. RT-CGM can help achieve better maternal peripartum