Intended for healthcare professionals

Rapid response to:

Papers

Twice daily versus four times daily insulin dose regimens for diabetes in pregnancy: randomised controlled trial

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7219.1223 (Published 06 November 1999) Cite this as: BMJ 1999;319:1223

Rapid Response:

Treatment of diabetes in pregnancy

Dear Sir

In the randomised control trial of diabetic treatment in pregnant
women with diabetes, Nachem et al1, achieved better glycaemic control with
a four times daily regimen when compared with a standard two times daily
regimen. We have some concerns about the methods and analysis.

The authors compared baseline data between the two groups. Glycaemic
control was measured using Fructosamine, Capillary whole blood glucose and
HbA1c. We feel they could improve the study by stating baseline control
in the pregestational group. This would have demonstrated that the two
groups were comparable and the previous diabetic control had not
influenced the results.

We noted that the two groups were given different methods of insulin
administration. The four times daily regimen used pens, whilst the twice
daily used injections. Therefore we question, was the improvement in
control due to better compliance2 rather than the regimen used?

Another potential source of bias was the non-blind nature of the
study. We note the higher levels of insulin in the four times daily
group. This may reflect more aggressive monitoring and treatment by
clinicians. Blinding of the clinicians, whilst difficult to achieve,
would have ensured the same treatment for both groups.

Yours sincerely

Shikha Chattree

Hayden Ellis

Emma Poyner

Jonathan Smith

Anna Zoltowski

3rd Year Medical Students

Department of Epidemiology & Public Health,
University of Newcastle

References:
(1) Nachum Z, Ben-Shlomo I, Weiner E, Shalev E. Twice daily versus four
times daily insulin dose regimens for diabetes in pregnancy: randomised
controlled trial. BMJ.1999;319:1223-1227

(2) Dunbar JM, Madden PM, Gleeson DT, Fiad TM, McKenna TJ. Premixed
insulin preparations in pen syringes maintain glycemic control and are
preferred by patients. Diabetes Care 1994;17:874-8

Words 197

Competing interests: No competing interests

25 November 1999
Emma Poyner
medical student
University of Newcastle