Predictors for antenatal insulin requirement in gestational diabetes

Abstract

The purpose of this study was to identify pre-gestational and gestational factors predicting subsequent insulin requirement in patients with gestational diabetes mellitus (GDM). Maternal parameters were compared between mothers achieving glycemic control with or without the addition of antenatal insulin therapy (AIT). Insulin was required only in 8/83 (10%) patients for glycemic control. Those who needed insulin had a stronger family history of diabetes and higher first hour plasma glucose along with multiple (>1) abnormal values during oral glucose tolerance test (OGTT) in univariate analysis (p < 0.05). The first hour plasma glucose value of ≥9.72 mmol/l predicted requirement of AIT in GDM mothers with a sensitivity of 100% and specificity of 73%. However, only positive family history of diabetes mellitus among first degree relatives and multiple abnormal values in OGTT were independent predictors for antenatal insulin requirement in regression analysis.

Chinese abstract

本研究的目的是探讨妊娠期糖尿病（gestational diabetes mellitus ，GDM）患者孕期是否需要使用胰岛素治疗的孕前及孕期的预测因素。比较了除饮食控制和适当运动外，需要和不需要用胰岛素治疗(antenatal insulin therapy,AIT)来控制血糖的两组孕妇的各项参数。在83例妊娠期糖尿病患者中，只有8例需要用胰岛素来控制血糖。这些孕妇有更明显的糖尿病家族史；口服葡萄糖耐量试验（oral glucosetolerance test，OGTT）多项值（大于1项）高出正常范围且1小时血糖值明显高于不需要使用胰岛素的孕妇（p<0.05）。1小时血糖值≥9.72 mmol/l对于预测GDM的孕妇是否应用AIT的敏感性为100%，特异性为73%。然而，回归分析显示：只有一级亲属有糖尿病家族史和OGTT多项值异常是预测孕期需使用胰岛素治疗的独立预测因素。

• Body mass index
• gestational diabetes
• insulin