Intrapartum continuous subcutaneous insulin infusion vs intravenous insulin infusion among pregnant individuals with type 1 diabetes mellitus: a randomized controlled trial

Background Intrapartum glucose management is critical to reducing neonatal hypoglycemia shortly after birth. While it is known that insulin is required for all pregnant individuals with T1DM, the optimal mode of intrapartum glycemic control is not known. Objective To compare the effect of intrapartum usage of continuous subcutaneous insulin infusion (CSII) versus intravenous (IV) insulin infusion for glucose management among pregnant individuals with type 1 diabetes mellitus (T1DM) on neonatal blood glucose levels. Study Design This was a randomized controlled trial of pregnant participants with T1DM. After written informed consent, participants were randomly allocated to one of two intrapartum insulin administration strategies: continuation of their CSII or IV insulin infusion. The primary outcome was the first neonatal blood glucose level. Results Between March 2021 and April 2023, seventy-six participants were approached, and 70 participants were randomized (35 participants in the IV insulin infusion group and 35 participants in the CSII group). Both groups were similar in terms of age, race/ethnicity, pre-gravid body mass index, nulliparity, and gestational age at delivery. There was no statistically significant difference in the first neonatal glucose measurement between both groups (50.1±23.4 vs. 49.2±22.6, p=0.86). Additionally, there were no statistically significant differences in any secondary neonatal outcomes. Approximately 57.1% of neonates in the CSII group required either oral, IV, or both treatments for hypoglycemia, while 51.4% of neonates in the IV infusion group required treatment. In both groups, 28.6% of neonates required IV treatment for hypoglycemia. Conclusion Pregnant individuals with T1DM utilizing either IV insulin infusion or continuation of their CSII for intrapartum insulin administration had no difference in the primary outcome of neonatal hypoglycemia. Patients should be given the option for both glycemic management strategies intrapartum.