The Effects of Local Insulin Injection on Cesarian Section Incisional Wound Healing Outcomes in Diabetic Pregnant Patients: A Randomized Clinical Trial

Abstract

Background: Diabetes, a prevalent condition during pregnancy, delays wound healing and exacerbates wound complications through various mechanisms. Given insulin's established anabolic effects in mitigating diabetic complications and accelerating wound healing, as well as the importance of improving pregnancy outcomes in diabetic mothers, this clinical trial investigates-for the first time in Iran-the impact of local insulin injections on wound healing and final outcomes, including reduced mortality and morbidity. Methods: Four hundred pregnant women with gestational or type 2 diabetes, undergoing uncomplicated cesarean sections while receiving insulin therapy, were randomly allocated to two equal groups. The intervention group received 0.2 units/kg of regular insulin diluted in 5 ml of water subcutaneously around the cesarean incision site once daily on postoperative days 1, 2, 3, 5, and 7. The primary outcomes were surgical site infection, wound dehiscence, and necrotizing fasciitis, assessed clinically by signs of purulent drainage or cellulitis, and by laboratory tests indicative of inflammation and infection. Findings: Demographic and baseline data were comparable between the two groups. Comparison of the intervention and control groups revealed no significant differences in the rates of surgical site cellulitis, purulent drainage, wound dehiscence, or necrotizing fasciitis. No cases of hypoglycemia or the need for wound closure interventions were observed in either group. Conclusion: Topical application of regular insulin around the cesarean incision in pregnant women with diabetes did not reduce wound complications. © 2025 Isfahan University of Medical Sciences(IUMS). All rights reserved.