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Recording available 2/16-5/2
Recording available 2/16-5/2
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AIUM Credit
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 4

Category: Diabetes

Poster Session 4

(1155) Streamlining glycemic control: subcutaneous insulin for intrapartum diabetes management

Thursday, February 12, 2026
3:30 PM - 5:00 PM  
Objective:
Optimal intrapartum glycemic control for patients with gestational diabetes (GDM) and type 2 diabetes (T2DM) is uncertain. Management usually relies on initiation of intravenous (IV) insulin once a glucose threshold is met. In 2024, our unit implemented a subcutaneous (SC) insulin protocol, replacing the routine initiation of IV insulin. We hypothesized the change would not alter neonatal outcomes and would improve nursing (RN) satisfaction.

Study Design:

This retrospective cohort quality improvement study included patients with GDM or T2DM who delivered at ≥ 36 weeks between March 2021 and June 2025. The protocol was implemented July 2024; July was excluded as a washout period. Patient demographics, maternal, and neonatal outcomes were compared before and after protocol implementation. The primary outcome was neonatal hypoglycemia or NICU admission for hypoglycemia within 24 hours of life. Secondary outcomes included IV insulin duration and RN satisfaction (3-item Likert Survey). Modified Poisson regression with interrupted time series assessed time trends and shifts in outcomes. Multivariable logistic regression evaluated associations between insulin modality and the primary outcome. Surveys were analyzed by Wilcoxon rank-sum tests.

Results:

Of 995 deliveries that met inclusion criteria, 221 experienced the primary outcome. The composite rate fell from 23% pre-intervention to 20% post (p=0.225). Each pre-intervention month was associated with a nonsignificant 0.9% increase in event rate (IRR 1.01, 95% CI 0.99-1.02). The 65 RN survey responses pre-intervention and 56 RN surveys post-intervention indicated improved satisfaction with management (29.2% vs 51.8%, p=0.0324). 

Conclusion:

Implementing an initial SC insulin protocol for managing intrapartum blood glucose did not lead to an increase in neonatal hypoglycemia or related NICU admissions. Nurses reported significantly higher satisfaction with the SC protocol. Initiating SC insulin at the glycemic threshold, rather than automatically starting IV insulin, was found to be a safe and preferred alternative for intrapartum glucose management.