Intrapartum maternal glycemic control in women with insulin requiring diabetes: a randomized clinical trial of rotating fluids versus insulin drip.

Overview

OBJECTIVE: The purpose of this study was to determine whether continuous insulin infusion provides a greater degree of intrapartum maternal glycemic control than rotating between glucose and non-glucose containing intravenous fluids. STUDY DESIGN: Laboring patients with pregestational or gestational diabetes were recruited and randomized to an "insulin drip" or "rotating fluids" protocol. The primary outcome measure was mean maternal capillary blood glucose (CBG) levels (mg/dL). Power analysis indicated that 16 patients were needed in each arm to find a difference of 10 mg/dL. RESULTS: Fifteen patients were randomized to the rotating fluids protocol and 21 patients to an insulin drip. There was no difference in mean intrapartum maternal CBG levels (103.9 +/- 8.7 mg/dL and 103.2 +/- 17.9 mg/dL in the rotating fluids and insulin drip group, respectively, P = .89). Neonatal outcomes were also similar between the 2 treatment groups. CONCLUSION: In patients with insulin requiring gestational diabetes, intrapartum glycemic control may be comparable with a standard adjusted insulin drip or a rotation of intravenous fluids between glucose and non-glucose containing fluids.