COMPARAÇÃO DOS EFEITOS DO USO DE INSULINA DE ORIGEM HUMANA COM A ANÁLOGA NO TRATAMENTO DA DIABETES MELLITUS GESTACIONAL: UMA REVISÃO SISTEMÁTICA E METANÁLISE

Abstract

Gestational Diabetes Mellitus (GDM) represents a significant challenge during pregnancy, requiring strict glycemic control to mitigate the risk of maternal and fetal complications, such as neonatal metabolic disorders and the future development of type 2 diabetes in the mother. Insulin therapy is a mainstay in the management of GDM when lifestyle modifications are insufficient. This study aimed to compare the efficacy and safety of human insulin versus analogue insulin in the treatment of GDM. For this purpose, a systematic review and meta-analysis of randomized controlled trials (RTC) identified in the PubMed, Cochrane and Embase databases were performed. The primary outcome assessed was glycemic control, specifically fasting glucose and 1-hour postprandial glucose; secondary outcomes included hypoglycemia. Risk of bias assessment of included studies was performed using the RoB 2 tool, and statistical analyses were conducted using a random-effects model. Seven RTC were included in the analyses. The results indicated that there was no significant difference in fasting blood glucose between the insulin analogue and human groups (SMD = -0.40; 95% CI: -0.85, 0.06; Z = 1.20; P = 0.23). However, for 1-hour postprandial blood glucose, the insulin analogue was significantly more effective in reducing blood glucose levels (mean difference -13.15; 95% CI -15.25, -11.04). Additionally, no statistically significant difference in the risk of hypoglycemia was found between the two types of insulin (RR 1.05; 95% CI: 0.39, 2.81). It is concluded that analog insulins are superior to human insulina in controlling 1-hour postprandial glycemia in pregnant women with GDM, presenting a comparable safety profile in relation to hypoglycemia.