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

Abstract

Aims: To identify factors predicting a need for insulin therapy in gestational diabetes mellitus (GDM) by comparing plasma glucose (PG) levels in a 75-g oral glucose tolerance test (75-g OGTT) with those in a 500-kcal meal tolerance test (MTT) containing 75 g of carbohydrate.
 Subjects and methods: The MTT was performed in 61 patients who diagnosed with GDM by a 75-g OGTT (age, 33.2 ± 4.5 years; prepregnancy body mass index, 22.6 ± 4.7 kg/m2; number of gestational weeks, 25.1 ± 6.4 weeks). PG and serum insulin levels were measured before the meal and up to 180 min after the meal. The insulin secretion capacity and resistance index were calculated.
 Results: PG levels increased from 86.8 ± 8.8 mg/dL at fasting to 132.7 ± 20.1 mg/dL at 30 min, and 137.8 ± 27.7 mg/dL at 60 min after MTT in the 35 patients with needed insulin therapy; these levels were significantly higher than those in the 26 patients, who only needed diet therapy. The patients with needed insulin therapy had significantly higher fasting PG levels in the 75-g OGTT, PG levels at fasting and 30 min after the MTT, and homeostasis model assessment of insulin resistance (HOMA-IR), and a significantly lower disposition index (DI) and insulin index than patients treated by diet alone. Receiver operating characteristic curve analysis was performed for factors involved in insulin therapy, with the following cutoff values: fasting PG in the 75-g OGTT, 92 mg/dL; PG 30 min after MTT, 129 mg/dL; HOMA-IR, 1.51; DI, 3.9; HbA1c, 5.4%. Multivariate analysis revealed that the 30-min PG level after MTT and HOMA-IR predicted insulin therapy.
 Conclusion: PG levels at 30 min after MTT may be useful for identifying patients with GDM, who need insulin therapy.

Isolated Maternal Hypothyroxinemia May be Associated with Insulin Requirement in Gestational Diabetes Mellitus

“…We could not analyze pre-conceptional BMI or serum insulin levels during OGTT. We found that higher HbA1c levels at the diagnosis predicted insulin requirement in GDM, similarly in the previous studies 33 36 . Actually, an increased HbA1c level may already be expected to be an important determinant of insulin use in a pregnant woman with GDM.…”

“…Maternal age, previous history of GDM, family history of type 2 diabetes mellitus, pre-conceptional body mass index, FBG, 1st-hour or 2nd-hour glucose level on OGTT, and HbA1c were found as predictors for insulin use in GDM 32 33 34 . In the other studies, the gestational week at the time of the diagnosis of GDM, abdominal subcutaneous fat thickness, and HOMA-IR were associated with insulin treatment in GDM 34 35 36 . IMH was not analyzed as a predictor for insulin use in GDM in any previous study.…”

“…Also, we found that the HbA1c cutoff value of 38,8 mmol/ mol was not associated with insulin requirement. In a previous study, HOMAIR was shown to be associated with insulin require ment in GDM [36]. We did not measure plasma insulin levels, and hence, could not calculate HOMAIR scores.…”

Processing Alaska Pollock Protein (Theragra chalcogramma) into Kamaboko Protein Mitigates Elevated Serum Cholesterol and Postprandial Glucose Levels in Obese Zucker fa/fa Rats

“…The nutritional intake during MTT is more balanced than that during OGTT. Therefore, MTT accurately detects the effects of functional components in models of insulin resistance [ 54 , 55 ]. As humans spend most of their time after eating, observing the course of glucose regulation after MTT is more interesting than observing fasting glucose concentration.…”

Investigation of Insulin Secretion in Glucose Tolerance Test by the Intake of Novel Imeglimin (Twymeeg)

“…IGI is also used in the case of meal tolerance test (MTT) [23]. Comparison study with GTT and MTT was found [24]. Authors et al investigated IRI and Cpeptide responses for MTT [25,18].…”