Publication:

Glycemic control, maternal and neonatal outcomes in gestational diabetes mellitus treated with regular aspart insulin in comparison with regular human insulin

Background Gestational diabetes mellitus (GDM) is associated with adverse maternal and neonatal outcomes, making optimal glycemic control essential during pregnancy. Rapid-acting insulin analogues may provide better postprandial glucose control than regular human insulin. This study aimed to compare glycemic control and maternal and neonatal outcomes among women with GDM treated with regular aspart insulin versus regular human insulin.

Methods This randomized controlled trial was conducted at the outpatient Department of Obstetrics and Gynaecology, BIRDEM General Hospital, Dhaka, from October 2023 to January 2025. A total of 102 women diagnosed with GDM after 24 weeks' gestation were randomly assigned to receive regular aspart insulin (Group I, n=54) or regular human insulin (Group II, n=48). Follow-up was performed at 28-, 32- and 36-weeks’ gestation and after delivery. Ninety-five participants completed follow-up (49 and 46, respectively). Fasting blood sugar (FBS), HbA1c, birth weight and maternal and neonatal outcomes were compared. Statistical significance was set at p<0.05.

Results Group I achieved significantly lower FBS than Group II at 28, 32 and 36 weeks' gestation and postpartum (all p<0.0001). HbA1c and birth weight were comparable between groups. Maternal complications did not differ significantly. Neonatal hypoglycaemia occurred less frequently in Group I than Group II (6.1% vs 19.6%, p=0.048).

Conclusion Regular aspart insulin provided superior fasting glycemic control and reduced neonatal hypoglycaemia compared with regular human insulin, without increasing maternal complications, supporting its use as an effective treatment option for GDM.