October 22, 2012

Levemir or NPH During Pregnancy?


Diabetes control is nonnegotiable when it comes to peace of mind when you are expecting.  A study published in Diabetes Care examined the outcomes of pregnant women with Type 1 Diabetes on either Levemir or NPH insulin.

The objective of the study was to compare the efficacy and safety of insulin detemir (Levemir) and neutral protamine Hagedorn (NPH). Both basal insulins were supplemented with insulin aspart (NovoLog or NovoRapid) for meals and corrections.

The study followed 310 pregnant women with T1D, 158 taking NPH and 152 taking Levemir, up to 12 months before pregnancy or during pregnancy at 8-12 weeks. At 36 weeks, the women taking Levemir had an average HbA1c of 6.27% and the women taking NPH had an average HbA1c of 6.33%.  Based on the full-scale of 36 weeks, Levemir was declared “noninferior” to NPH.

Okay, so at the end of the pregnancy, NPH and Levemir were head-to-head. But how did they fare in the previous gestational weeks?

It turns-out that Levemir had a significant advantage during week 24, when your baby is beginning to fill-out proportionately, the brain is developing quickly, and your baby’s respiratory system is branching-out. The average fasting blood glucose of awomen on NPH was  113 mg/dL compared to women on Levemir, who averaged 96 mg/dL.

The conclusions of the study found that the rates of hypoglycemia were comparable, as were the resulting HbA1c. However, considering that HbA1c is a snapshot of the average glucose reading in a 12 week period – are you truly comfortable with an average reading for the health of your baby? Clearly the fasting blood glucose readings were remarkable enough to pull ahead in the race to demonstrate Levemir is a choice contender for Type 1 diabetes control during pregnancy.

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