Risk Factors That can Predict Antenatal Insulin Need in Gestational Diabetes

Abstract

BackgroundThis study was undertaken to assess the association between insulin need in gestational diabetes mellitus (GDM) and clinical features and laboratory parameters. Factors that can predict insulin need are also identified.MethodsCases with GDM were included retrospectively from records. Cases which failed to achieve target blood glucose levels with medical nutrition therapy (MNT) and need insulin treatment were recorded. Risk factors which can predict antenatal insulin treatment (AIT) were identified as follows; the presence of diabetes in a first degree relative, body mass index prior to pregnancy, number of parity, history of GDM, macrosomic baby delivery (> 4,000 g), age, gestational week at time of diagnosis, body mass index during diagnosis, weight gain untill diagnosis, mean systolic and diastolic blood pressure, HbA1C level during diagnosis, and fasting plasma glucose on diagnostic oral glucose tolerance test. Presence of a statistical significance between those patient features and AIT was assessed. Independent predictors for AIT were evaluated.ResultsA total of 300 cases were recruited from records, 190 cases (63.3%) were followed only with MNT until delivery and 110 cases (36.7%) were initiated AIT. The association between AIT and patient factors like presence of diabetes in the pedigree, week of gestation at which GDM was diagnosed, BMI during diagnosis, HbA1C levels, and fasting plasma glucose during diagnosis was found (P = 0.03; 0.008; 0.049; 0.001 and 0.001respectively). Multivariant analysis showed that fasting plasma glucose levels during diagnosis and HbA1C levels were independent risk factors for AIT. Fasting plasma glucose values that can predict AIT were identified > 89.5 mg/dL with 72.7% sensitivity and 62.6% spesifity (P < 0.001). Positive predictive value was 73% (P < 0.001). Also, HbA1C levels that can predict AIT was found to be > 5.485% with 65.3% sensitivity and 66.7% spesifitiy(P < 0.001) with a positive predictive value 68% (P < 0.001).ConclusionsIndependent predictors for AIT were found as fasting plasma glucose on OGTT and HbA1c levels during diagnosis in GDM. Cases with fasting plasma glucose ≥ 89.5 mg/dL or HbA1C ≥ 5.485% should be closely followed for AIT in specified centers.

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

“…Consistent with the current study, a number of other studies have identified clinical and biochemical variables associated with a need for insulin therapy in GDM [3][4][5][6][7][8][9][10][11][12]. The majority of these identified independent predictors of therapy type using multivariable logistic regression analysis [3][4][5][6][7][8][9]12].…”

“…The majority of these identified independent predictors of therapy type using multivariable logistic regression analysis [3][4][5][6][7][8][9]12]. Many identified the same predictors of insulin that were found in the present study, such as elevated pre-pregnancy BMI [4,5,8,9], elevated OGTT fasting glucose [3,4,6,8,9], elevated HbA 1c at GDM diagnosis [3,5,9], a history of GDM in a previous pregnancy [9], a family history of type 2 diabetes [3,5] and an earlier diagnosis of GDM [3,7,8].…”

“…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.…”

“…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].…”

Assessment of predictors of insulin therapy in patients with gestational diabetes diagnosed according to the IADPSG criteria

“…The insulin group had a younger gestational age at diagnosis of gestational diabetes. Some studies have demonstrated that the fasting glucose level on OGTT [14][15][16][17] and the gestational week at diagnosis [14][15][16]18] are associated with the requirement for insulin therapy. The initial abnormality in glucose intolerance is postprandial hyperglycemia [13,19].…”