Detemir vs neutral protamine Hagedorn insulin for diabetes mellitus in pregnancy: a comparative effectiveness, randomized controlled trial.
Michal Fishel Bartal, Clara Ward, Sean C Blackwell...
https://pubmed.ncbi.nlm.nih.gov/33865836/Actively Recruiting
Led by University of California, Los Angeles · Updated on 2023-09-26
336
Participants Needed
1
Research Sites
N/A
Total Duration
Researchers are comparing the rates of neonatal hypoglycemia in pregnant women with type 2 diabetes or gestational diabetes using two types of long-acting insulin insulin detemir and insulin NPH. This phase 2 randomized controlled trial explores how these insulins affect both mothers and newborns, aiming to improve diabetes management during pregnancy and reduce risks such as preeclampsia, preterm delivery, and neonatal complications. Insulin detemir is FDA-approved for type 1 diabetes in pregnancy and has a known safety profile, while insulin NPH is currently the only approved treatment for type 2 diabetes or gestational diabetes during pregnancy. Participants are randomly assigned to receive either insulin detemir or insulin NPH as their long-acting insulin to control blood sugar levels during pregnancy. The study is open-label, meaning both participants and researchers know which insulin is being used. The focus is on comparing the safety and effects of these two treatments during pregnancy through regular monitoring and follow-up. During the study, researchers will monitor newborns for hypoglycemia within the first 24 hours and beyond until hospital discharge. Additional assessments include measuring neonatal hormone levels, rates of pregnancy-induced hypertension, delivery mode, gestational age, maternal glycemic control, and infant health indicators up to one year after birth. Participants will undergo regular evaluations to track blood sugar control and any pregnancy or neonatal complications, with a total study duration that covers pregnancy and one year postpartum.
CONDITIONS
DETERMINE: Detemir vs NPH
M
Michael Richley, MD
C
Christina Han, MD
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University of California, Los Angeles
Lead Sponsor
This table compares participation in this trial with other options available for this condition. The information is drawn from published research and the trial’s study details and is provided for educational purposes only.
| Factors | Insulin Detemir | Insulin NPH |
|---|---|---|
| What it is | A long-acting basal insulin analog, used to regulate blood sugar levels during pregnancy for women with type 2 diabetes or gestational diabetes requiring insulin. | A long-established intermediate-acting basal insulin (neutral protamine Hagedorn), used to manage blood sugar in pregnant women with type 2 diabetes or gestational diabetes on insulin. |
| Primary use | To maintain maternal blood glucose within target range and reduce adverse neonatal outcomes, such as hypoglycemia, in pregnant women with type 2 diabetes or gestational diabetes. | To manage maternal hyperglycemia and minimize neonatal hypoglycemia and other pregnancy complications in women with type 2 diabetes or gestational diabetes requiring insulin therapy. |
| How it is given | Administered via subcutaneous injection according to individualized dosing for blood glucose control during pregnancy. | Given by subcutaneous injection, titrated to blood sugar targets based on established pregnancy protocols. |
| Evidence status | Clinical trial data and published studies suggest that insulin detemir provides comparable glycemic control and pregnancy outcomes to NPH insulin in pregnant women with diabetes. | Studies support NPH insulin as an effective and established basal insulin for managing diabetes in pregnant women, with similar efficacy and maternal-neonatal outcomes compared to detemir. |
| Important limitations | Further research may be needed to confirm long-term maternal and neonatal safety profiles, and applicability to broader populations or ethnic groups. Clinical experience is less extensive than NPH insulin. Some rare hypersensitivity reactions have been reported. | NPH insulin use may be associated with higher risk of hypoglycemic episodes due to its intermediate action profile. Individual response varies, and less flexibility compared to newer insulin analogs. |
Disclaimer: This comparison is created with the help of artificial intelligence(AI) and may contain errors or missing information. It is not medical advice and does not mean one option is better or safer than another. Clinical trials are still being studied, and joining a trial is your choice. Please consult your healthcare professional before making any decisions.
You may qualify if you...
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Duration - 2 to 4 weeks
Participants are screened for eligibility to participate in the trial.
1 visit (in-person)
Duration - During pregnancy until delivery
Participants receive either insulin detemir or insulin NPH to manage blood sugar during pregnancy.
Regular visits for insulin management and monitoring during pregnancy
Duration - Up to 1 year after delivery
Participants and their newborns are monitored for maternal and neonatal outcomes for up to 1 year after delivery.
Periodic visits during the first year postpartum for health assessments
Study Type
INTERVENTIONAL
Masking
NONE
Allocation
RANDOMIZED
Model
PARALLEL
Primary Purpose
TREATMENT
Number of Arms
2
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Lead Sponsor