Insulin detemir (Levemir) versus NPH insulin (Humulin N) in pregnant women with type 1 diabetes

This study compared the efficacy of two insulin types in pregnant women with type 1 diabetes mellitus (T1DM). HbA1c levels were similar with either insulin type, while the fasting plasma glucose was lower with insulin detemir (Levemir) use.

Due to destruction of insulin-producing cells in the pancreas, T1DM patients have very low insulin levels; it is not enough to control blood sugar. T1DM requires continuous treatment with insulin. It is usually given in two forms: long or intermediate-acting and short-acting. The different types were designed to mimic the body’s natural patterns of insulin production. Short-acting insulin is given before meals, while the other types are usually given in the evening (their effect is milder and longer). NPH insulin is an intermediate-acting insulin, while insulin detemir is a long-acting insulin.

Pregnancy in T1DM women exposes the mother and fetus to many risks which can be prevented by tightly controlling blood sugar levels. The glycated hemoglobin (or HbA1c) test result reflects the average blood sugar level for the past 2-3 months. The fasting plasma glucose test (FPG) measures the blood sugar level after several hours of fasting.

The present study included 310 pregnant women with T1DM. 152 patients were treated with insulin detemir, while 158 received NPH insulin. Around half of the patients in each group began treatment before conception, while the other half began treatment 8-12 weeks into the pregnancy. HbA1c levels were similar at 36 weeks: 6.27% with insulin detemir, 6.33% under insulin NPH. The FPG was significantly lower in the insulin detemir group versus NPH at both 24 and 36 weeks into the pregnancy. There was no significant difference in the number of episodes of hypoglycemia (low blood sugar) between the two groups.

The results suggest that these two insulin types have comparable efficacy and safety profiles. However, larger trials are needed to confirm these findings, especially with regard to adverse effects on the mother and fetus.

This study was funded by Novo Nordisk, the manufacturer of insulin detemir.

Patients should read the FDA drug information for insulin detemir (Levemir).