Insulin Degludec in Pregestational Diabetes: Evidence and Perspectives

Overview

Journal Arch Med Sci Atheroscler Dis

Date 2024 Jun 7

PMID 38846058

Authors

Georgios S Papaetis

Konstantinos C Mikellidis

Affiliations

Soon will be listed here.

Abstract

Pregestational diabetes is described when a woman with diabetes before the onset of pregnancy becomes pregnant and consequently she is vulnerable to higher risk for adverse outcomes in the embryo/foetus. Strict glycaemic control, with minimal glucose variability, starting from before conception and maintained throughout pregnancy decreases significantly adverse foetal and maternal outcomes; maternal hypoglycaemic episodes are the major barrier in achieving this goal. Insulin degludec is an ultralong-acting analogue, which has half-life of over 25 h and full duration of effect of more than 42 h, reaching a steady-state serum concentration after 2-3 days of its administration. It promotes flat, steady, peakless and predictable insulin concentrations, with minor intra-individual and inter-individual variability. It also exerts a low mitogenic/metabolic potency ratio. This review examines thoroughly all current evidence of the administration of insulin degludec in pregestational diabetes as well as its future role in this population.

References

Blum A . Insulin Use in Pregnancy: An Update. Diabetes Spectr. 2016; 29(2):92-7. PMC: 4865394. DOI: 10.2337/diaspect.29.2.92. View

Metzger B, Lowe L, Dyer A, Trimble E, Chaovarindr U, Coustan D . Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358(19):1991-2002. DOI: 10.1056/NEJMoa0707943. View

Oya J, Nakagami T, Hasegawa Y, Katamine A, Kondo Y, Babazono T . Comparative clinical outcomes of insulin degludec and insulin glargine 300 U/mL after switching from other basal insulins in real-world patients with type 1 and type 2 diabetes. J Diabetes Investig. 2021; 12(11):1983-1991. PMC: 8565408. DOI: 10.1111/jdi.13559. View

Henao-Carrillo D, Munoz O, Gomez A, Rondon M, Colon C, Chica L . Reduction of glycemic variability with Degludec insulin in patients with unstable diabetes. J Clin Transl Endocrinol. 2018; 12:8-12. PMC: 5992319. DOI: 10.1016/j.jcte.2018.03.003. View

Farrar D, Tuffnell D, West J, West H . Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes. Cochrane Database Syst Rev. 2016; (6):CD005542. PMC: 8563847. DOI: 10.1002/14651858.CD005542.pub3. View

Russell-Jones D, Gall M, Niemeyer M, Diamant M, Del Prato S . Insulin degludec results in lower rates of nocturnal hypoglycaemia and fasting plasma glucose vs. insulin glargine: A meta-analysis of seven clinical trials. Nutr Metab Cardiovasc Dis. 2015; 25(10):898-905. DOI: 10.1016/j.numecd.2015.06.005. View

Lepercq J, Lin J, Hall G, Wang E, Dain M, Riddle M . Meta-Analysis of Maternal and Neonatal Outcomes Associated with the Use of Insulin Glargine versus NPH Insulin during Pregnancy. Obstet Gynecol Int. 2012; 2012:649070. PMC: 3362948. DOI: 10.1155/2012/649070. View

Formoso G, Ginestra F, Di Dalmazi G, Consoli A . Empagliflozin, metformin and insulin degludec, during pregnancy: a case report. Acta Diabetol. 2018; 55(7):759-761. DOI: 10.1007/s00592-018-1134-y. View

Carroll M, Schade D . The dawn phenomenon revisited: implications for diabetes therapy. Endocr Pract. 2005; 11(1):55-64. DOI: 10.4158/EP.11.1.55. View

10.

Mathiesen E, Hod M, Ivanisevic M, Garcia S, Brondsted L, Jovanovic L . Maternal efficacy and safety outcomes in a randomized, controlled trial comparing insulin detemir with NPH insulin in 310 pregnant women with type 1 diabetes. Diabetes Care. 2012; 35(10):2012-7. PMC: 3447831. DOI: 10.2337/dc11-2264. View

11.

Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan B . IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2021; 183:109119. PMC: 11057359. DOI: 10.1016/j.diabres.2021.109119. View

12.

Britton L, Hussey J, Berry D, Crandell J, Brooks J, Bryant A . Contraceptive Use Among Women with Prediabetes and Diabetes in a US National Sample. J Midwifery Womens Health. 2018; 64(1):36-45. PMC: 6351213. DOI: 10.1111/jmwh.12936. View

13.

Goldenberg R, Aroda V, Billings L, Christiansen A, Meller Donatsky A, Rizi E . Effect of insulin degludec versus insulin glargine U100 on time in range: SWITCH PRO, a crossover study of basal insulin-treated adults with type 2 diabetes and risk factors for hypoglycaemia. Diabetes Obes Metab. 2021; 23(11):2572-2581. PMC: 9290717. DOI: 10.1111/dom.14504. View

14.

Roman-Gonzalez A, Builes-Barrera C, Aristizabal Baron A . Exposure to Degludec During Pregnancy: A Case Report. Cureus. 2019; 11(7):e5158. PMC: 6743655. DOI: 10.7759/cureus.5158. View

15.

Papaetis G . SGLT2 inhibitors, intrarenal hypoxia and the diabetic kidney: insights into pathophysiological concepts and current evidence. Arch Med Sci Atheroscler Dis. 2024; 8:e155-e168. PMC: 10811536. DOI: 10.5114/amsad/176658. View

16.

Ringholm L, Do N, Damm P, Mathiesen E . Pregnancy outcomes in women with type 1 diabetes using insulin degludec. Acta Diabetol. 2022; 59(5):721-727. PMC: 8853215. DOI: 10.1007/s00592-021-01845-0. View

17.

Papaetis G, Papakyriakou P, Panagiotou T . Central obesity, type 2 diabetes and insulin: exploring a pathway full of thorns. Arch Med Sci. 2015; 11(3):463-82. PMC: 4495144. DOI: 10.5114/aoms.2015.52350. View

18.

Bonora B, Avogaro A, Fadini G . Exposure to insulin degludec during pregnancy: report of a small series and review of the literature. J Endocrinol Invest. 2018; 42(3):345-349. DOI: 10.1007/s40618-018-0926-9. View

19.

Di Cianni G, Torlone E, Lencioni C, Bonomo M, Di Benedetto A, Napoli A . Perinatal outcomes associated with the use of glargine during pregnancy. Diabet Med. 2008; 25(8):993-6. PMC: 2613261. DOI: 10.1111/j.1464-5491.2008.02485.x. View

20.

Sugrue R, Zera C . Pregestational Diabetes in Pregnancy. Obstet Gynecol Clin North Am. 2018; 45(2):315-331. DOI: 10.1016/j.ogc.2018.01.002. View