Assessment of predictors of insulin therapy in patients with gestational diabetes diagnosed according to the IADPSG criteria

Abstract

Aims and introduction It is helpful for both diabetologists and obstetricians to identify patients with gestational diabetes who require insulin therapy for glycemic control during pregnancy. The aim of the present study was to assess potential predictors of insulin requirement in patients with gestational diabetes. Materials and methods One hundred thirteen patients with gestational diabetes [mean age 34.2 ± 4.5 years; pre-gestational body mass index (BMI), 23.6 ± 6.0 kg/m 2 ] were included in this study. The associations between insulin requirement and the following factors were analyzed: clinical maternal characteristics, number of abnormal oral glucose tolerance test (OGTT) values, gestational age at diagnosis, plasma glucose levels measured during the OGTT, glycated hemoglobin (HbA1c) and glycated albumin levels, and serum C-peptide level before breakfast and 1 and 2 h after breakfast. Results Thirty-six patients (32 %) required insulin during pregnancy (''insulin group''); the remaining patients were treated with nutrition therapy (''nutrition group''). The insulin group had a higher pre-gestational BMI, higher fasting glucose level, higher area under the curve (AUC) for serum C-peptide level, higher HbA1c level, and a younger gestational age at diagnosis than the nutrition group (p \ 0.05, all). Logistic regression analysis showed that the pre-gestational BMI, AUC for serum C-peptide level, and the HbA1c level were independent predictors for the insulin group (p \ 0.05, all). Conclusions The results suggest that a high insulin resistance and HbA1c level may be associated with insulin requirement in patients with gestational diabetes.

Correlation between Oral Glucose Tolerance Test Abnormalities and Adverse Pregnancy Outcomes in Gestational Diabetes: A Cross-Sectional Study

“…We found that fasting abnormality was a positive predictor for insulin therapy, a result similar to other studies [ 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. The mean fasting glucose among our women on insulin was higher than those who were on diet therapy, with no significant difference noted in the postprandial level.…”

Associations between maternal characteristics and pharmaceutical treatment of gestational diabetes: an analysis of the UK Born in Bradford (BiB) cohort study

“…Although the specificity of these studies largely varied (eg, location, sample size, screening methods, diagnostic thresholds), they consistently showed that as maternal BMI increased, so did the risk of being treated with insulin. 12–15 32 34 36–38 Regarding the associations between smoking and GDM treatment, some studies showed that more smokers were treated with insulin than lifestyle changes, 15 33 39 while others found an opposite relationship, 38 40 although the differences between groups in these studies were not reported to be statistically significant. A more recent study has reported that smoking was associated with a higher risk of insulin treatment, although this was relative to women without GDM and women with GDM not requiring insulin treatment combined in the same control group.…”

Predictors of later insulin therapy for gestational diabetes diagnosed in early pregnancy

“…In this study, the incidence of requiring insulin therapy later in pregnancy was 52.5% in women with E-GDM and a pre-pregnancy BMI ≥25 kg/m 2 and/or a family history of DM. Previously, it was reported that higher pre-pregnancy BMI and a family history of T2DM were associated with later insulin therapy in GDM diagnosed using the IADPSG criteria (diagnosed after 24 gestational weeks) [28,29]. According to our criteria, women with a pre-pregnancy BMI ≥25 kg/m 2 and a family history of diabetes were assigned to the first trimester screening positive group and received an OGTT in the first trimester, resulting in most women with these risk factors being diagnosed with GDM before 24 weeks of gestation.…”