One‐hour oral glucose tolerance test plasma glucose at gestational diabetes diagnosis is a common predictor of the need for insulin therapy in pregnancy and postpartum impaired glucose tolerance

Abstract

Aims/IntroductionGestational diabetes mellitus (GDM) is a risk for adverse perinatal outcomes, and patients with a history of GDM have an increased risk of impaired glucose tolerance (IGT). Here, we carried out two non‐interventional and retrospective studies of GDM patients in Japan.Materials and MethodsIn the first study, we enrolled 529 GDM patients and assessed predictors of the need for insulin therapy. In the second study, we enrolled 185 patients from the first study, and assessed predictors of postpartum IGT.ResultsIn the first study, gestational weeks at GDM diagnosis and history of pregnancy were significantly lower, and pregestational body mass index, family history of diabetes mellitus, 1‐ and 2‐h glucose levels in a 75‐g oral glucose tolerance test (OGTT), the number of abnormal values in a 75‐g OGTT, and glycated hemoglobin were significantly higher in participants receiving insulin therapy. In the second study, 1‐ and 2‐h glucose levels in a 75‐g OGTT, the number of abnormal values in a 75‐g OGTT, glycated hemoglobin, and ketone bodies in a urine test were significantly higher in participants with OGT. Logistic regression analysis showed that gestational weeks at GDM diagnosis, 1‐h glucose levels in a 75‐g OGTT and glycated hemoglobin were significant predictors of the need for insulin therapy, and 1‐h glucose levels in a 75‐g OGTT at diagnosis and ketone bodies in a urine test were significant predictors for postpartum IGT.ConclusionsAntepartum 1‐h glucose levels in a 75‐g OGTT was a predictor of the need for insulin therapy in pregnancy and postpartum IGT.

A comparison of meal tolerance test and oral glucose tolerance test for predicting insulin therapy in patients with gestational diabetes

“…Physicians need to establish at the time of diagnosis of GDM whether insulin therapy is required for glycemic control. In previous studies, risk factors for insulin therapy in patients with three abnormal values in the OGTT results were similar to those identified in the present study ( 18 ). However, some patients were treated with insulin even if they had only one abnormal value in a 75-g OGTT result or mild glucose intolerance, making it difficult to identify high-risk GDM on the basis of OGTT results alone.…”

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

“…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.…”

Bimodal distribution of fasting, one and two hour post load plasma glucose in Asian Indian pregnant women without pre-gestational diabetes: Gestational age related changes

“…Bergman et al [34] reported a longitudinal association of elevated 1-h PG > 8.6 mmol/l (155 mg/dl) with and without impaired glucose tolerance with cumulative incidence of diabetes over 24 years in a non diabetic cohort. In pregnant women too, the need for insulin therapy is higher in those with high 1-h PG values in OGTT [35]. For GDM diagnosis, 1- h PG estimation is recommended by most professional organizations like IADPSG [13], WHO [14] and International Diabetes Federation [36], but has not been included in the NICE diagnostic criteria [12].…”