Adoption of a pregnancy-specific intravenous insulin protocol (Pregnancy-IVI) at a regional centre has equivalent safety and efficacy outcomes as a tertiary hospital

Women with diabetes in pregnancy (DIP) are at risk of hyperglycaemia during hospitalisation for administration of antenatal glucocorticoids, intercurrent illness and labour. Variable rate intravenous insulin (VRII) is commonly used to maintain maternal glucose at physiological levels, to minimise maternal ketoacidosis, fetal acidosis and neonatal hypoglycaemia. The Pregnancy-IVI is the most-studied VRII protocol, and has established efficacy and safety following betamethasone in gestational diabetes mellitus and pre-existing diabetes mellitus. However, implementation has only been reported at tertiary care hospitals, and it is unclear whether VRII can be safely implemented in secondary care hospitals in regional areas, particularly with reference to the risk of maternal hypoglycaemia.