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

Abstract

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.

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.…”

Different Gestational Diabetes Phenotypes: Which Insulin Regimen Fits Better?

“…We obtained similar results with our prediction model, integrating all the maternal and metabolic significant variables associated to the need of insulin. Nonetheless, Ducarme failed to combine maternal characteristics and biological parameters to develop an accurate model ( 13 ).…”

“…For instance, early diagnosis of GDM (<24 weeks of gestation), older maternal age, pre-pregnancy BMI>30, previous GDM, family history of diabetes are reported as associated factors to insulin treatment ( 9 – 12 ). Biochemical parameters indicating poor metabolic glycemic control at the diagnosis of GDM can also predict the need of insulin therapy: HbA1c at diagnosis >5.5% and elevated 1-h and 2-h plasma glucose level at OGTT has been reported to be predictors of pharmacological treatment ( 13 , 14 ).…”

A Review on Research Progress in the Application of Glycosylated Hemoglobin and Glycated Albumin in the Screening and Monitoring of Gestational Diabetes

“…79,80 Others consider that HbA1c is a reference for insulin therapy but the cut-offs are different. [81][82][83][84][85][86] Tang et al consider that patients with HbA1C≥5.3 require treatment with insulin. 81 González-Quintero et al consider that patients with HbA1C≥6 require treatment with insulin.…”