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Recording available 2/16-5/2
Recording available 2/16-5/2
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Oral Concurrent Session 2 - Diabetes

Oral Concurrent Sessions

Oral Concurrent Session 2 - Diabetes

(20) A RCT of Patient-led Insulin Titration for Glycemic Management with Gestational Diabetes Mellitus

Wednesday, February 11, 2026
1:15 PM - 1:30 PM  
Location: Summit 211 - 214
Objective:
We conducted a RCT to compare whether patient-led insulin titration (intervention) compared with provider-led insulin titration (control) resulted in improved glycemic management and pregnancy outcomes for individuals with GDM.

Study Design:
EMPOWER was a single-center, non-blinded RCT among individuals with GDM requiring insulin between 20-32 weeks. Intervention participants self-titrated long-acting insulin starting at 10 units nightly and increased or decreased by 2 units per fasting glucose above or below 70-95 mg/dL, respectively, every day. Control participants started insulin with weekly titration at the provider’s discretion. The primary outcome was mean fasting glucose in the 36th week or the week prior to delivery for preterm deliveries. Secondary outcomes included pregnancy outcomes and patient-reported measures. With 80% power, 56 individuals needed to be randomized to demonstrate at least a 15% difference in mean glucose.

Results:
Of 89 screened and eligible individuals, 56 were randomized (29 intervention/27 control). The median duration from starting insulin to delivery was 7.7 weeks. Patient-led insulin titration resulted in a similar weekly average glucose before delivery compared with provider-led titration (88.8 vs. 90.3 mg/dL; b coef.: -1.50 mg/dL; 95%CI: -5.50-2.50), but was associated with lower odds of LGA (6.5 vs. 39.3%; OR: 0.10, 95%CI 0.02-0.55) and NICU admission (9.7 vs. 32.0%; OR: 0.23, 95%CI: 0.05-0.98)(TABLE). Patient-led insulin titration resulted in more rapid normalization of fasting glucose than provider-led insulin titration (mean: 1.8 vs. 2.5 weeks; HR: 1.48, 95%CI: 1.16-1.90)(FIGURE). Other pregnancy and patient-reported outcomes did not differ between the groups.

Conclusion:
Patient-led self-insulin titration for GDM did not result in lower fasting glucose before delivery compared with provider-led insulin titration but was associated with a significantly lower risk of LGA and NICU admission and a quicker time to achieving glycemic control. These data support the need for patient-centered GDM treatment strategies.