Short-acting insulin analogues deemed safe, effective in pregnancy. (Data Lacking on Long-Acting Analogues).

LITTLE ROCK, ARK. -- Short-acting insulin analogues are safe and optimal for use in insulin-requiring diabetic pregnancies, but there are not enough data yet to recommend the new long-acting analogues for pregnant women, Dr. Lois Jovanovic said.

Until enough data are available to eliminate concerns about potential immunogenicity with the new long-acting insulin analogue glargine (Lantus), basal insulin needs during pregnancy should be delivered with either lispro or aspart in an insulin infusion pump or with the use of two or three injections a day of NPH insulin, she said at the annual meeting of the North American Diabetes in Pregnancy Study Group.

Studies in women with both gestational diabetes mellitus and pregestational diabetes showed that the short-acting analogues lispro (Humalog) and aspart (Novolog)--created by switching amino acids to make simpler molecules that break down faster at the injection site--effectively normalized postprandial glucose values, did not cross the placenta, and were not more immunogenic than regular insulin.

In a recent multicenter trial of women with type 1 or 2 diabetes who took lispro throughout gestation, the congenital anomaly rate was no different than what is seen with human insulin, said Dr. Jovanovic, ...