Prediction of insulin therapy in women with gestational diabetes: a systematic review and meta-analysis of observational studies

Abstract

Objectives To identify antenatal risk factors that may predict the need for insulin treatment upon diagnosis of gestational diabetes (GDM), that is, to identify the specific characteristics of women diagnosed with GDM who did not achieve good glycemic control through lifestyle modifications. Methods We performed a comprehensive literature search in PubMed, Science Direct, Ebsco, and Scielo for studies evaluating the associations between antenatal factors and the need for insulin treatment published until January 28th, 2021. Random-effects models were used to estimate risk ratios and their 95% confidence interval. The quality of studies was assessed using the Newcastle-Ottawa Scale. Random-effects models were used to estimate outcomes, and effects reported as risk ratio and their 95% confidence interval. The systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews. Results Eighteen observational studies were selected, reporting 14,951 women with GDM of whom 5,371 received insulin treatment. There were statistically significant associations between the need for insulin treatment and BMI ≥ 30 (RR:2.2; 95%CI: 1.44–3.41), family history of type 2 diabetes mellitus (RR:1.74; 95%CI: 1.56–1.93), prior personal history of GDM (RR:2.10; 95%CI: 1.56–2.82), glycated hemoglobin value at GDM diagnosis (RR:2.12; 95%CI: 1.77–2.54), and basal glycemia obtained in the diagnostic curve (RR: 1.2; 95%CI: 1.12–1.28). Nulliparity and maternal age were not determinants factor. There was moderate-to-high heterogeneity among the included studies. Conclusions the strong causal association between BMI ≥ 30, family history of type 2 diabetes mellitus, prior history of GDM and glycosylated hemoglobin with the need for insulin treatment was revealed.

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, 1 st -hour or 2 nd -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].…”

Precision gestational diabetes treatment: a systematic review and meta-analyses

“…Our second systematic review extends the observations of a previous systematic review reporting maternal characteristics associated with the need for insulin treatment in GDM 11 . We identified a number of additional precision markers of successful GDM treatment with lifestyle measures alone, without need for additional pharmacological therapy.…”

“…This delay resulting in continued exposure to hyperglycaemia poses a risk of accelerated foetal growth 9 , 10 . Previous research has suggested that maternal characteristics including body mass index (BMI) ≥ 30 kg/m 2 , family history of type 2 diabetes, prior history of GDM and higher glycated haemoglobin (HbA1c) increase the likelihood of need for insulin treatment in GDM 11 , indicating the potential for risk-stratification of women to streamline successful GDM management. There is emerging evidence that precision biomarkers predict treatment response in type 2 diabetes, which has similar heterogeneity to GDM 12 , 13 and thus gives rationale to investigate whether a similar precision approach could be successful in optimising outcomes in GDM.…”

Precision Gestational Diabetes Treatment: Systematic review and Meta-analyses

“…This delay resulting in continued exposure to hyperglycaemia poses a significant risk of accelerated fetal growth 9,10 . Previous research has suggested that maternal characteristics including body mass index (BMI) ≥30 kg/m 2 , family history of type 2 diabetes, prior history of GDM and higher glycated haemoglobin (HbA1c) increase the likelihood of need for insulin treatment in GDM 11 , indicating the potential for risk-stratification of women to streamline successful GDM management. There is emerging evidence that precision biomarkers predict treatment response in type 2 diabetes, which has similar heterogeneity to GDM 12,13 and thus gives rationale to investigate whether a similar precision approach could be successful in optimizing outcomes in GDM.…”