Gestational Diabetes Mellitus (GDM): Relationship Between Higher Cutoff Values for 100 g Oral Glucose Tolerance Test (OGTT) and Insulin Requirement During Pregnancy

Abstract

Objectives To study if there is any relationship about higher cutoff values for 100 g oral glucose tolerance test and the need for insulin in women diagnosed with gestational diabetes. Materials and Methods This is a retrospective population-based study of 201 women diagnosed with Gestational Diabetes Mellitus (GDM) between January 2012 and June 2014 in the area of Oviedo, Asturias, Spain. According to diagnostic criteria recommended by GEDE, NDDG, gestational diabetes is diagnosed if two or more plasma glucose levels meet or exceed the following threshold: fasting glucose of 105 mg/dl, 1-h 190 mg/dl, 2-h 165 mg/dl, or 3-h 145 mg/dl. We aim to know if there is any relationship between higher cutoffs and insulin requirement. Results 36 out of 201 patients (17.91%) needed insulin to achieve the targets of blood glucose control. There were no differences in mean maternal age and birthweights. Fasting blood glucose levels were significantly higher in women with further need for insulin than those who only needed diet and exercise (p < 0.001). Also, blood glucose levels 2 h after the oral glucose intake were statistically different between the two groups (p 0.032). AUC for fasting glucose value was the highest according to ROC curve. Conclusions Fasting cutoff vales for 100 g oral glucose tolerance test are consistently higher in women diagnosed with Gestational Diabetes that further needed insulin to achieve adequate blood glucose control. The positive predictive value of fasting glucose value 105 mg/dl on OGTT was 81.1%, whereas for the cut-off 95 mg/dl it was 54.0%.

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.…”

“…The insulin requirement among our GDM women (8.7%) was low in comparison to other published data (10.8–52.8%) [ 5 , 20 , 21 , 22 , 26 , 27 , 28 ]. Singapore, which has a similar multi-ethnic population to Malaysia, reported a comparable rate to ours (5.6–10.4%) [ 32 ].…”

“…Ares et al found that the two-hour plasma glucose level was significantly higher in the insulin-treated group [ 20 ]. The study, alongside several others, discovered that the post-glucose load abnormalities were significant predictors of insulin requirement among GDM women [ 20 , 21 , 23 , 26 , 27 ]. We found that two-hour glucose derangement was significantly associated with diet therapy and reduced the risk of insulin usage.…”

Adverse effects of gestational diabetes-related risk factors on pregnancy outcomes and intervention measures

“…According to a previous study (17), the risk of GDM in people with a previous history of GDM during multiple pregnancies is 13.2 times that of those without a history of GDM, and the risk of GDM in those who have twice previous histories of GDM is 25.9 times that of those without a history of GDM. In addition, the risk of GDM is closely related to the postprandial hyperglycemia and high HbAIc of pregnant women (18). The 2hPBG does not meet the standard, indicating impaired glucose tolerance.…”

Elevated first trimester C-reactive protein as a predictor of gestational diabetes

“…Gestational diabetes is present when two or more of the following venous plasma concentrations are equaled or exceeded: fasting, 105mg/dl, and after a 100 gm of oral glucose load, plasma glucose values of 190mg/dL at 1 hr, and 165 mg/dL at 2 hr, and 145 mg/dL at 3 hr. 9 While perinatal problems for mother and baby are decreased by fastidious diabetic control, the incidence of hydramnios, preeclampsia, eclampsia, infections and prematurity are increased even in carefully managed diabetic pregnancies. 10 There is no doubt that impressive strides have been made with regard to diabetes in pregnancy, so that at present time the expectation of the diabetic mother regarding pregnancy performance and fetal outcome can be fairly similar to that of a nondiabetic patent.…”