Gestational diabetes mellitus: Who requires insulin therapy?

Wong, Vincent W.; Jalaludin, Bin

doi:10.1111/j.1479-828x.2011.01329.x

Cited by 77 publications

(89 citation statements)

References 20 publications

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“…These include early GDM diagnosis (e.g. at <25 weeks gestation), a family history of diabetes, nonEuropean ethnicity, an older age, elevated fasting blood glucose level (BGL) and HbA 1c at GDM diagnosis, and an elevated pre-pregnancy BMI [3][4][5][6][7][8][9][10][11][12]. Despite the identification of individual independent predictors of the need for insulin therapy in GDM, only a few studies have attempted to use these factors to develop a model for predicting therapy type (either MNT or MNT+I) in women with GDM [3,5,11].…”

Section: Introductionmentioning

confidence: 99%

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A novel validated model for the prediction of insulin therapy initiation and adverse perinatal outcomes in women with gestational diabetes mellitus

et al. 2016

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Aims/hypothesis Identifying women with gestational diabetes mellitus who are more likely to require insulin therapy vs medical nutrition therapy (MNT) alone would allow risk stratification and early triage to be incorporated into risk-based models of care. The aim of this study was to develop and validate a model to predict therapy type (MNT or MNT plus insulin [MNT+I]) for women with gestational diabetes mellitus (GDM). Methods Analysis was performed of de-identified prospectively collected data from women diagnosed with GDM by criteria in place since 1991 and formally adopted and promulgated as part of the more detailed 1998 Australasian Diabetes in Pregnancy Society management guidelines. Clinically relevant variables predictive of insulin therapy by univariate analysis were dichotomised and included in a multivariable regression model. The model was tested in a separate clinic population. Results In 3317 women, seven dichotomised significant independent predictors of insulin therapy were maternal age >30 years, family history of diabetes, pre-pregnancy obesity (BMI ≥30 kg/m 2 ), prior GDM, early diagnosis of GDM (<24 weeks gestation), fasting venous blood glucose level (≥5.3 mmol/l) and HbA 1c at GDM diagnosis ≥5.5% (≥37 mmol/mol). The requirement for MNT+I could be estimated according to the number of predictors present: 85.7-93.1% of women with 6-7 predictors required MNT+I compared with 9.3-14.7% of women with 0-1 predictors. This model predicted the likelihood of several adverse outcomes, including Caesarean delivery, early delivery, large for gestational age and an abnormal postpartum OGTT. The model was validated in a separate clinic population. Conclusions/interpretation This validated model has been shown to predict therapy type and the likelihood of several adverse perinatal outcomes in women with GDM.

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Section: Introductionmentioning

confidence: 99%

“…A number of studies have successfully identified one or more clinical or biochemical characteristics present at the time of GDM diagnosis that are associated with the need for insulin treatment [3][4][5][6][7][8][9][10][11][12]. These include early GDM diagnosis (e.g.…”

Section: Introductionmentioning

confidence: 99%

A novel validated model for the prediction of insulin therapy initiation and adverse perinatal outcomes in women with gestational diabetes mellitus

et al. 2016

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“…Factors that predict requirement of insulin therapy included elevated BMI, high fasting glucose level on OGTT, and history of previous GDM [37]. Offspring of women on insulin therapy had higher birth weight and birth-weight percentile than those of women on MNT, but there was no difference in neonatal morbidity including APGAR scores or need for neonatal intensive care support [37]. The need for insulin therapy also varied between different ethnic groups.…”

Section: Insulin Therapymentioning

confidence: 99%

“…The proportion of women with GDM requiring insulin therapy varied between different studies, ranging between 20% and 50% [19,37]. Factors that predict requirement of insulin therapy included elevated BMI, high fasting glucose level on OGTT, and history of previous GDM [37]. Offspring of women on insulin therapy had higher birth weight and birth-weight percentile than those of women on MNT, but there was no difference in neonatal morbidity including APGAR scores or need for neonatal intensive care support [37].…”

Section: Insulin Therapymentioning

confidence: 99%

“…The women are usually started on a small dose, and SMBG is essential to guide the titration of the insulin doses. The proportion of women with GDM requiring insulin therapy varied between different studies, ranging between 20% and 50% [19,37]. Factors that predict requirement of insulin therapy included elevated BMI, high fasting glucose level on OGTT, and history of previous GDM [37].…”

Section: Insulin Therapymentioning

confidence: 99%

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Gestational Diabetes Mellitus: a review of the diagnosis, clinical implications and management

Wong

2013

RHC

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Gestational diabetes mellitus (GDM) is a condition that affects the wellbeing of mother and fetus. Women with GDM are at risk of type 2 diabetes mellitus in the future, while fetal exposure to hyperglycaemia in-utero may affect their glycometabolic profile later in life. Appropriate screening and management of this problem is important in ensuring good pregnancy outcomes. In this review, the clinical implications, the various ways to screen and diagnose GDM, and management strategies during pregnancy will be discussed. For years, insulin is the mainstay of treatment if medical nutrition therapy fails to maintain adequate glycaemic control, but use of other oral pharmacotherapy may gain greater acceptance in the future. Following delivery, ongoing follow-up of these women is worthwhile as early intervention through lifestyle or pharmacotherapy may prevent the development of diabetes.

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Predictive factors of subsequent insulin requirement for glycemic control during pregnancy at diagnosis of gestational diabetes mellitus

Ducarme

Roure

Grange

et al. 2019

Intl J Gynecology & Obste

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Objective To determine maternal and biological parameters at diagnosis of gestational diabetes mellitus (GDM) as predictors of antenatal insulin therapy (AIT) for glycemic control. Methods In this planned secondary analysis of a prospective observational study, we recruited women diagnosed with GDM between July 1, 2014, and October 31, 2015. Maternal and biological parameters were analyzed as predictors of AIT using multivariable logistic regression analyses. Predictive accuracy of a cut‐off value for a biological predictor was determined using the area under the receiver operating characteristic curve (AUC) and the Youden index (J). Results Of 200 women included (mean gestational age 22 ± 6 weeks), 72 (36%) required AIT. No maternal characteristic was associated with AIT. Glycated hemoglobin (HbA1c; adjusted odds ratio [aOR] 3.15, 95% CI 1.03–9.69) and elevated 1‐hour oral glucose tolerance test (OGTT; aOR 1.23, 95% CI 1.13–1.46) were predictors of AIT. Analyses suggested inaccurate prediction of AIT, with an optimal cut‐off HbA1c value of 5.4% (J=0.14; AUC 0.58, 95% CI 0.48–0.67), and an optimal 1‐hour plasma glucose OGTT value of 1.77 mg/dL (J=0.24; AUC 0.62, 95% CI 0.50–0.74). Conclusion HbA1c at diagnosis of GDM and elevated 1‐hour OGTT were independent predictors of AIT for glycemic control. Clinicaltrials.gov: NCT02159378.

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Gestational diabetes mellitus: Who requires insulin therapy?

Abstract: Women with GDM who require insulin therapy differ from those who can be managed on MNT alone. Being aware of factors that predict failure of MNT could help diabetes services develop a more efficient model of care in the management of women with GDM.

Cited by 77 publications

References 20 publications

A novel validated model for the prediction of insulin therapy initiation and adverse perinatal outcomes in women with gestational diabetes mellitus

A novel validated model for the prediction of insulin therapy initiation and adverse perinatal outcomes in women with gestational diabetes mellitus

Gestational Diabetes Mellitus: a review of the diagnosis, clinical implications and management

Predictive factors of subsequent insulin requirement for glycemic control during pregnancy at diagnosis of gestational diabetes mellitus

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