Antenatal insulin therapy in gestational diabetes mellitus: validation of the new Brugmann scores

Abstract

Background

Following the adoption of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for gestational diabetes mellitus (GDM) diagnosis by the World Health Organization (WHO) in 2014, many investigators have tried to identify independent risk factors for antenatal insulin therapy (AIT). The purpose of the current study is to build and validate a score that stratifies patients according to their need for AIT.

Methods

All pregnant women diagnosed with GDM according to the IADPSG definition were included. Group 1 comprised patients of 2018, and group 2 comprised patients of 2019. Each group was divided into two subgroups: subgroup A comprised patients diagnosed according to the 75-g oral glucose tolerance test (OGTT), and subgroup B comprised patients diagnosed according to fasting plasma glucose (FPG).

Results

A total of 1298 patients were included; 19.3% of those diagnosed by OGTT and 40.9% by FPG required AIT. The risk for AIT was stratified as low, moderate, and high. Brugmann FPG score comprised six risk factors and Brugmann OGTT score 12. Higher scores were associated with higher risk for AIT. The use of these scores in the two subgroups of group 2 showed no statistical differences compared to group 1.

Conclusions

Both Brugmann FPG and OGTT scores may be useful to stratify patients with GDM according to their need for AIT. Future studies should be conducted to prospectively validate these scores, and to examine whether or not using oral anti-hyperglycemic agents in a high-risk group may decrease the need for AIT.

摘要

背景：2014年世界卫生组织（WHO）采用了国际糖尿病与妊娠研究协会（IADPSG）的妊娠糖尿病（GDM）诊断标准, 许多研究人员试图确定产前胰岛素治疗（AIT）的独立风险因素。本研究目的是建立并验证一个评分系统, 根据患者对AIT的需求对患者进行分层。

方法：纳入所有根据IADPSG定义诊断为GDM的孕妇。第一组为2018年纳入的患者, 第二组为2019年纳入的患者。每组分为两个亚组：A亚组包括根据75-g口服葡萄糖耐量试验（OGTT）诊断的患者, B亚组包括根据空腹血糖（FPG）诊断的患者。

结果：共纳入1298名患者；19.3%的根据OGTT诊断的患者和40.9%的根据FPG诊断的患者需要AIT。AIT的风险分为低、中、高。Brugmann FPG评分包括六个风险因素, Brugmann OGTT评分为12分。得分越高, 患AIT的风险越高。与第一组相比, 第二组的两个亚组在这两个评分系统应用上没有显示出统计学差异。

结论：Brugmann FPG和OGTT评分可能有助于根据患者对AIT的需求对GDM患者进行分层。未来研究应前瞻性地验证这些评分系统, 并检测高危人群是否通过口服降糖药物可减少对AIT的需求。

Keywords:

• Antenatal insulin therapy
• gestational diabetes mellitus
• medical nutritional therapy
• oral glucose tolerance test
• scores

Ethics approval

The study was approved by the ethical committee of University Hospital Brugmann (number CE2020/139) on September 8 2020.

Disclosure statement

The authors have no conflict of interest.

Conceptualization (D.A.B., J.C.J.); Data curation (D.A.B., C.K.); Formal analysis (D.A.B., A.C., O.D., L.I., J.C.J.); Funding acquisition (L.I., J.C.J.); Investigation (D.A.B., C.K., A.C., O.D., L.I., F.B., G.C.T.); Methodology (D.A.B., A.C., J.C.J.); Project administration (J.C.J.); Resources (L.I., J.C.J.); Software (D.A.B.); Supervision (J.C.J); Validation (A.C., L.I., F.B., G.C.T.); Visualization (D.A.B., C.K., O.D.); Writing - original draft (D.A.B., C.K., A.C., O.D.); Writing - review & editing (L.I., F.B., G.C.T., J.C.J.).

Data availability statement

The data that support the findings of this study are available from the corresponding author [JCJ] upon reasonable request.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.