Comparison of the Efficacy of Intensive Insulin Therapy Regimens for Type A2 Gestational Diabetes Mellitus and Their Effects on Maternal and Infant Metabolic Indices

Background: Type A2 gestational diabetes mellitus (A2GDM) is a challenging subtype of gestational diabetes, requiring insulin therapy in addition to exercise and dietary interventions. While multiple daily subcutaneous injections of regular insulin (RI) and insulin pumps are commonly used, their clinical efficacy and impact on maternal and infant metabolic indices remain unclear. Methods: This retrospective study included 98 patients with A2GDM admitted to Puer People’s Hospital between March 2021 and September 2023. Patients were divided into a control group (n = 41) and an experimental group (n = 57) receiving insulin via an insulin pump. Both groups received treatment until delivery, and treatment efficacy, glucose metabolism, lipid metabolism, and maternal and infant complications were compared. Results: Pre-pregnancy, the experimental group had a lower body mass index (BMI) and fewer cases with a family history of diabetes. The experimental group achieved blood glucose targets faster, required a lower insulin dose, and had fewer hypoglycemic events (p < 0.05). Post-treatment, the experimental group showed greater improvements in fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2hPBG), glycosylated hemoglobin (HbAlc), and homeostasis model assessment of insulin resistance (HOMA-IR), and lipid profile (total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], and low-density lipoprotein cholesterol [LDL-C]), with significantly better maternal and neonatal outcomes (p < 0.05). Complication rates were lower in the experimental group, including pregnancy-induced hypertension, cesarean section, polyhydramnios, and neonatal complications like macrosomia, hypoglycemia, and jaundice. Conclusions: Multiple subcutaneous injections via insulin pump, that simulates physiological insulin secretion, requires a lower insulin dose for managing A2GDM and demonstrates superior efficacy in blood glucose control, improvement of glucose and lipid metabolism, as well as enhancement of both maternal and neonatal outcomes.