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Multiple positive points during the 75 g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeks.

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  • معلومة اضافية
    • المصدر:
      Publisher: Asian Association for the Study of Diabetes and Blackwell Pub. Asia Country of Publication: Japan NLM ID: 101520702 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2040-1124 (Electronic) Linking ISSN: 20401116 NLM ISO Abbreviation: J Diabetes Investig Subsets: MEDLINE
    • بيانات النشر:
      Original Publication: Tokyo : Asian Association for the Study of Diabetes and Blackwell Pub. Asia
    • الموضوع:
      Diabetes, Gestational*/drug therapy ; Diabetes, Gestational*/blood ; Diabetes, Gestational*/diagnosis ; Glucose Tolerance Test* ; Insulin*/therapeutic use ; Insulin*/administration & dosage ; Blood Glucose*/analysis; Humans ; Pregnancy ; Female ; Adult ; Hypoglycemic Agents/therapeutic use ; Hypoglycemic Agents/administration & dosage ; Risk Factors ; Retrospective Studies ; Gestational Age ; Prognosis ; Pregnancy Trimester, First
    • نبذة مختصرة :
      Aims/introduction: This study evaluated the risk factors for insulin therapy before 24 gestational weeks (early insulin therapy) in pregnant women with gestational diabetes diagnosed before 24 gestational weeks (E-GDM).
      Materials and Methods: This study included 530 singleton mothers with E-GDM who underwent a 75 g oral glucose tolerance test (OGTT) in the first trimester at Keio University Hospital between January 2013 and December 2021. E-GDM can be classified according to its management into only diet therapy until delivery (Diet E-GDM), insulin therapy started before 24 gestational weeks (EarlyIns E-GDM), and insulin therapy started after 24 gestational weeks (LateIns E-GDM). We analyzed the risk factors for EarlyIns E-GDM.
      Results: Patients with EarlyIns E-GDM had a significantly higher maternal age at delivery, pre-pregnancy BMI, first trimester hemoglobin A1c, 1 h plasma glucose levels (1 h-PG), and 2 h-PG, as well as a more pronounced initial increase and subsequent decrease, compared with those in the Diet E-GDM group. However, the Apgar scores at both 1 and 5 min were significantly lower in patients with EarlyIns E-GDM than in those with Diet E-GDM. The number of abnormal values in the OGTT showed the largest area under the receiver operating characteristic curve (AUC) for predicting EarlyIns E-GDM (0.83, 95% confidence interval [CI]: 0.79-0.86), followed by the 1 h-PG value (AUC: 0.81, 95% CI: 0.77-0.85). The initial increase showed the third largest AUC (0.78, 95% CI: 0.74-0.82).
      Conclusions: Although further research is needed, our data suggest the importance of early insulin therapy in cases of E-GDM with multiple abnormal OGTT values, especially with high 1 h-PG levels and initial increase.
      (© 2024 The Author(s). Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.)
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    • Grant Information:
      The Seiichi Imai Memorial Foundation Research Grant
    • Contributed Indexing:
      Keywords: Gestational diabetes mellitus; Insulin; Oral glucose tolerance test
    • الرقم المعرف:
      0 (Insulin)
      0 (Blood Glucose)
      0 (Hypoglycemic Agents)
    • الموضوع:
      Date Created: 20240919 Date Completed: 20241204 Latest Revision: 20241207
    • الموضوع:
      20250114
    • الرقم المعرف:
      PMC11615686
    • الرقم المعرف:
      10.1111/jdi.14318
    • الرقم المعرف:
      39297405