{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:38:06Z","timestamp":1792625886087,"version":"4.5.0"},"reference-count":13,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Insulin U-500 is a highly concentrated regular insulin that is five times stronger than standard U-100 and is used to treat severe insulin resistance. Glycemic data from continuous glucose monitoring (CGM) in relation to initiation of U-500 insulin in pregnancy with type 2 diabetes are limited. We examined CGM-derived glycemic measures before and after insulin U-500 transition during pregnancy among women with type 2 diabetes.<\/jats:p>\n                  <jats:p>We conducted a case-crossover study evaluating glycemic measures before and after transition to insulin U-500 during pregnancy among women with type 2 diabetes. The case period was from prenatal care to insulin U-500 transition, and the control period was after insulin U-500 transition to delivery. Outcomes included CGM metrics (time in range [TIR; 65\u2013140\u2009mg\/dL], time above range [TAR], and time below range), mean glucose and standard deviation, estimated A1c per glucose management indicator, coefficient of variation, and number of hypoglycemic episodes and were compared pre versus post insulin U-500 transition. Adjusted linear mixed models were used.<\/jats:p>\n                  <jats:p>Among 21 women with type 2 diabetes, the median gestational age at prenatal care initiation was 11.1 weeks, at insulin U-500 transition was 25.4 weeks, and at delivery was 37.1 weeks. The insulin U-500 dose at initiation was 300 units\/day and at delivery was 422.5 units\/day. The TIR was higher, and TAR and mean glucose were lower post versus pre insulin U-500 transition (p\u2009&lt;\u20090.05).<\/jats:p>\n                  <jats:p>In this cohort of pregnant women with type 2 diabetes, transition to insulin U-500 was associated with a modest improvement in some CGM-derived glycemic measures.<\/jats:p>","DOI":"10.1055\/a-2979-5956","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:45:01Z","timestamp":1792622701000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of Transition to Insulin U-500 during Pregnancy on Continuous Glucose Monitoring\u2013Derived Glycemic Metrics among Women with Type 2 Diabetes"],"prefix":"10.1055","author":[{"given":"Elizabeth O.","family":"Buschur","sequence":"additional","affiliation":[{"name":"The Ohio State University, Ohio, United States","place":["Columbus"],"department":["Department of Internal Medicine, Division of Endocrinology, Metabolism, and Diabetes"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Scheiber","sequence":"additional","affiliation":[{"name":"The Ohio State University, Ohio, United States","place":["Columbus"],"department":["Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiqiang","family":"Wu","sequence":"additional","affiliation":[{"name":"The Ohio State University, Ohio, United States","place":["Columbus"],"department":["Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabeth","family":"Brewton","sequence":"additional","affiliation":[{"name":"The Ohio State University, Ohio, United States","place":["Columbus"],"department":["Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven G.","family":"Gabbe","sequence":"additional","affiliation":[{"name":"The Ohio State University, Ohio, United States","place":["Columbus"],"department":["Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaylyn","family":"Vickers","sequence":"additional","affiliation":[{"name":"The Ohio State University, Ohio, United States","place":["Columbus"],"department":["Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark B.","family":"Landon","sequence":"additional","affiliation":[{"name":"The Ohio State University, Ohio, United States","place":["Columbus"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney","family":"Lynch","sequence":"additional","affiliation":[{"name":"The Ohio State University, Ohio, United States","place":["Columbus"],"department":["Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Grobman","sequence":"additional","affiliation":[{"name":"Brown University, Rhode Island, United States","place":["Providence"],"department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8206-5235","authenticated-orcid":false,"given":"Christine P.","family":"Field","sequence":"additional","affiliation":[{"name":"The Ohio State University, Ohio, United States","place":["Columbus"],"department":["Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8043-556X","authenticated-orcid":false,"given":"Kartik K.","family":"Venkatesh","sequence":"additional","affiliation":[{"name":"The Ohio State University, Ohio, United States","place":["Columbus"],"department":["Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/1471-0528.17587","article-title":"Rural-urban disparities in pregestational and gestational diabetes in pregnancy: serial, cross-sectional analysis of over 12\u2009million pregnancies","volume":"131","author":"K K Venkatesh","year":"2024","journal-title":"BJOG"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1097\/AOG.0000000000005640","article-title":"Insulin management for gestational and type 2 diabetes in pregnancy","volume":"144","author":"A M Valent","year":"2024","journal-title":"Obstet Gynecol"},{"issue":"07","key":"ref3","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1089\/dia.2022.0009","article-title":"Combination use of U-500 regular insulin via insulin pump and rapid-acting U-100 prandial injections for treatment of pre-existing type 2 diabetes in pregnancy","volume":"24","author":"E D Szmuilowicz","year":"2022","journal-title":"Diabetes Technol Ther"},{"issue":"10","key":"ref4","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s11892-018-1054-9","article-title":"Glucose targets and insulin choice in pregnancy: what has changed in the last decade?","volume":"18","author":"S Bacon","year":"2018","journal-title":"Curr Diab Rep"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"26","DOI":"10.2174\/1573399816666200408084614","article-title":"Insulin U-500, the practical solution for the treatment of patients with high insulin requirements","volume":"17","author":"N Mikhail","year":"2021","journal-title":"Curr Diabetes Rev"},{"issue":"18","key":"ref6","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.2146\/ajhp090554","article-title":"Use of concentrated insulin human regular (U-500) for patients with diabetes","volume":"67","author":"A R Segal","year":"2010","journal-title":"Am J Health Syst Pharm"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1038\/jp.2012.70","article-title":"U-500R and aspart insulin for the treatment of severe insulin resistance in pregnancy associated with pregestational diabetes","volume":"33","author":"I Okeigwe","year":"2013","journal-title":"J Perinatol"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1097\/AOG.0b013e31824fd27d","article-title":"Pregestational diabetes with extreme insulin resistance: use of U-500 insulin in pregnancy","volume":"120","author":"L C Zuckerwise","year":"2012","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.2337\/dc25-2342","article-title":"Pregnancy outcomes in individuals with Young-onset type 2 diabetes","volume":"49","author":"E Fortman","year":"2026","journal-title":"Diabetes Care"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S2213-8587(25)00335-3","article-title":"Application of continuous glucose monitoring and automated insulin delivery technologies for pregnant women with type 1, type 2, or gestational diabetes: an international consensus statement","volume":"14","author":"K Benhalima","year":"2025","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.2337\/diacare.28.5.1240","article-title":"The use of U-500 in patients with extreme insulin resistance","volume":"28","author":"E Cochran","year":"2005","journal-title":"Diabetes Care"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1097\/AOG.0b013e3182978a11","article-title":"Treatment of severe insulin resistance in pregnancy with 500 units per milliliter of concentrated insulin","volume":"122","author":"H Mendez-Figueroa","year":"2013","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref13","doi-asserted-by":"crossref","first-page":"162","DOI":"10.2337\/cd16-0057","article-title":"Development and implementation of a U-500 regular insulin program in a federally qualified health center","volume":"35","author":"K F Shaw","year":"2017","journal-title":"Clin Diabetes"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2979-5956.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:45:03Z","timestamp":1792622703000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2979-5956"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,21]]},"references-count":13,"URL":"https:\/\/doi.org\/10.1055\/a-2979-5956","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,21]]}}}