Patient-Led Insulin Titration for Glycemic Management With Gestational Diabetes Mellitus: A Randomized Controlled...

Area of Science:

• Endocrinology
• Obstetrics
• Clinical Trials

Background:

• Gestational diabetes mellitus (GDM) requires careful glycemic management.
• Insulin therapy is often necessary for GDM management.
• Patient-centered approaches to GDM treatment warrant investigation.

Purpose of the Study:

• To compare patient-led versus clinician-led insulin titration in GDM.
• To assess effects on glycemic control and pregnancy outcomes.
• To evaluate patient-reported outcomes in GDM management.

Main Methods:

• A single-center, nonblinded randomized controlled trial (RCT) involving 56 individuals with GDM.
• Intervention group: self-titrated long-acting insulin.
• Control group: clinician-led weekly insulin titration.
• Primary outcome: mean fasting glucose at 36 weeks gestation.

Main Results:

• Patient-led titration achieved similar mean fasting glucose (88.8 vs 90.3 mg/dL).
• Faster achievement of target fasting glucose (<95 mg/dL) in the patient-led group (1.8 vs 2.5 weeks).
• Significantly lower risk of macrosomia (6.9% vs 37.0%) and LGA birth weight (3.3% vs 34.6%) with patient-led titration.

Conclusions:

• Patient-led insulin titration is effective for GDM management.
• It offers faster glycemic control and reduces adverse birth outcomes.
• Supports further research into patient-centered GDM treatment strategies.