Application of glycemic qualification rate based on fingerstick glucose monitoring in women with gestational diabetes mellitus

Abstract

Objective

To explore the appropriate application of glycemic qualification rate (GQR) calculated by fingerstick blood glucose (BG) monitoring for patients with gestational diabetes mellitus (GDM) by analyzing the relationship between BG control and adverse pregnancy outcomes.

Methods

Fingerstick Blood Glucose data during the second and third trimester of singleton pregnant women diagnosed with GDM were collected. GQR which is defined as the percentage of fingerstick BG values reaching the targets of BG control in a period of time was calculated. Patients were divided into three groups according to tertiles (tertile 1, GQR <56.25%; tertile 2, GQR 56.25–75%; and tertile 3, GQR ≥75%). Pregnant outcomes were compared among the three groups. Univariate analysis and logistic regression were performed to analyze the potential relationship between GQR and pregnancy outcomes. Receiver operating characteristic (ROC) curves were calculated to determine the cutoff values. We also explored that whether twice or three times monitoring per day would be adequate for GQR calculation, so we brought in two or three glucose measuring times per day to explore the relationship between new GQR and adverse outcomes.

Results

A total of 311 patients diagnosed with GDM were analyzed. In univariate analysis, the incidences of cesarean section of tertile 1–3 groups were 61.4%, 58.7%, and 44.9%, respectively (p < .05). The incidences of neonatal hypoglycemia of tertiles 1–3 groups were 19.8%, 18.6%, and 8.7% (p < .05). The difference of composite outcomes was statistically significant (p = .001). After adjustment, the patients with worse BG control (lower GQR) had higher risk of cesarean section (tertile 1 – aOR = 2.029, 1.128–3.648), neonatal hypoglycemia (tertile 1: aOR = 2.498, 1.082–5.766) as well as composite outcomes. The ROC curve of GQR indicated the predictive value for neonatal hypoglycemia (area under the ROC curve (AUC) 0.612 (0.532–0.692)) and neonatal composite outcomes (AUC 0.593 (0.528–0.657)) with optimal cutoff values of 81.1% and 73.5%, respectively. We also explored that whether twice or three times monitoring per day would be adequate for GQR calculation. The result showed that GQR only calculated by FBG + 2hPG after lunch (2h AL) per day also had well relationship with cesarean section (tertile 1: OR = 2.412, 1.322–4.398), neonatal hypoglycemia (tertile 1: aOR = 4.497, 1.607–12.586), and neonatal composite outcomes (tertile 1: aOR = 1.959, 95% confidence interval (CI): 1.114–3.444, p = .020).

Conclusions

The GQR calculated by the easily applicable fingerstick BG is related to occurrence of cesarean section and neonatal hypoglycemia in GDM women. GQR ≥ 80% is recommended for better pregnancy outcomes. As for the number of points monitoring per day, GQR calculated by FBG + 2h AL was an optimal option for better pregnancy outcomes if mothers needed to simplify the process of monitoring.

Keywords:

• Gestational diabetes mellitus
• fingerstick blood glucose monitoring
• neonatal hypoglycemia
• cesarean section
• pregnancy outcome

Acknowledgements

The authors expressed appreciation to Jiabin Xie, for helpful advice for data analysis during the development of the study. Xie received no financial support for his participation.

Ethical approval

All methods were carried out in accordance with the relevant institutional guidelines and regulations. The study was approved by the ethics committees for clinical research and animal trials of the First Affiliated Hospital, Sun Yat-sen University (ethical approval numbers: [2020] 048). The study conforms to Declaration of Helsinki.

Author contributions

R.Z. performed the analysis and wrote the manuscript. X.C. and Y.L. conceived of the idea and designed the study. R.Z., N.C., and L.P. designed the research. C.X., C.W., H.L., and W.D. contributed to data collating, suggestion on statistical analysis, and revision of the manuscript. All authors read and approved the final manuscript. X.C. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Consent form

Informed consent for study participation was obtained from all participants (if subjects are under 16, from a parent and/or legal guardian).

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

All data generated and analyzed in this study are included in this published article. The datasets are available from the corresponding author on reasonable request.

Additional information

Funding

The study was supported by grants from the 5010 Project Foundation of Sun Yat-sen University (No. 2017001) and The Science and Technology Foundation of Guangzhou City (No. 201803010101).