Effects of insulin aspart on the efficacy, ultrasound imaging indicators and maternal and infant outcome in patients with gestational diabetes mellitus / 中国医师进修杂志

ABSTRACT

Objective:To analyze the effect of insulin aspart on the islet cell secretion function, ultrasound imaging indicators and maternal and infant outcome in patients with gestational diabetes mellitus (GDM).Methods:The clinical data of 120 patients with GDM in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from February 2017 to July 2019 were retrospectively analyzed. Among them, 60 cases were treated with insulin aspart (observation group) and 60 cases were treated with biosynthetic human insulin (control group). The efficacy indexes, ultrasound imaging indexes and maternal and infant outcome were compared.Results:The 2 h postprandial blood glucose (2 h PBG) after breakfast on the third and fifth day of treatment in observation group was significantly lower than that in control group (6.85 ± 0.87) mmol/L vs. (7.47 ± 1.35) mmol/L and (6.24 ± 0.59) mmol/L vs. (6.60 ± 0.87) mmol/L, and there was statistical difference ( P<0.01); there was no statistical difference in 2 h PBG after breakfast on the first day of treatment and after lunch and dinner on the first, third and fifth day of treatment between 2 groups ( P>0.05). The homeostasis model assessment-insulin resistance index (HOMA-IR) after treatment in observation group was significantly lower than that in control group (2.57 ± 0.25 vs. 3.00 ± 0.35), the homeostasis model assessment- β cell function index (HOMA-β) was significantly higher than that in control group (72.45 ± 12.33 vs. 63.66 ± 10.72), and there were statistical differences ( P<0.01). There were no statistical differences in pre-lunch blood glucose, pre-lunch initial insulin amount, pre-lunch final insulin amount and blood glucose target time between 2 groups ( P>0.05); the incidence of pre-meal hypoglycemia in observation group was significantly lower than that in control group 8.33% (5/60) vs. 23.33% (14/60), and there was statistical difference ( P<0.05). The umbilical artery and renal artery resistance index (RI), maximum systolic blood flow velocity and end-diastolic blood flow velocity ratio (S/D) after treatment in observation group were significantly lower than those in control group (RI 0.49 ± 0.16 vs. 0.59 ± 0.15 and 0.69 ± 0.17 vs. 0.76 ± 0.12; S/D 2.09 ± 0.22 vs. 2.38 ± 0.26 and 5.17 ± 0.45 vs. 5.77 ± 0.63), and there were statistical differences ( P<0.01 or <0.05). There were no statistical differences in gestational age, delivery mode, neonatal body weight and the incidences of macrosomia, neonatal hypoglycemia and neonatal referral between 2 groups ( P>0.05). Conclusions:Insulin aspart can significantly improve the islet cell secretion function and ultrasound imaging indexes in the treatment of GDM, and can reduce the risk of pre-meal hypoglycemia, but the effect on maternal and infant outcome remains to be explored.