Identifying the Risk Group for Insulin Therapy in Patients with Gestational Diabetes

Yıl 2022, , 59 - 66, 30.04.2022

Muhammet Cüneyt Bilginer , Yasemin Emür , Damla Tüfekçi , Hülya Coşkun , Ozge Üçüncü , İrfan Nuhoğlu , Mustafa Koçak

https://doi.org/10.25048/tudod.1036512

Öz

Aim: This study aims to determine the predictors of antenatal insulin therapy (AIT) in patients with gestational diabetes mellitus
(GDM) who applied to the outpatient endocrine clinic of a tertiary hospital.
Material and Methods: The study included 619 patients with GDM.Oral glucose tolerance test (OGTT), HbA1c (%), lipid levels, and
other biochemical measurements of two groups (patients with or without insulin use) were compared with Mann-Whitney U or Student
t-test. Demographic characteristics, obesity, and diet adherence were compared with the Chi-Square test. OGTT-75 measurements
between the three insulin groups (basal, bolus or both uses) were compared with ANOVA.
Results: In this study, 27.0% of the GDM patients needed insulin therapy. The insulin group had a significantly higher rate of obese,
morbidly obese, and poor diet adherence patients than the MNT group and had significantly higher values measured in the 75-g OGTT
(OGTT-75) for 0-h glucose, 2-h glucose, HbA1C (%), and triglyceride. In OGTT-75, all three measurement values (0-h, 1-h, 2-h glucose)
above the cut-off were associated with insulin requirement. In OGTT-75, 2-h glucose value > 151.5 mg/dL (68.4% sensitivity and 60.0%
specificity) predicted general need for insulin, and 0-h glucose value > 95.0 mg/dL (72.0% sensitivity and 69.0% specificity) predicted
the need for basal AIT.
Conclusion: We suggest identifying the risky group for insulin therapy at the time of diagnosis in GDM. Closer follow-up is required for
the patients found to be in the risk group for insulin therapy.

Anahtar Kelimeler

Gestational diabetes mellitus, Oral glucose tolerance test, İnsulin, Nutrition, Triglyceride, Glucose

Gestasyonel Diyabetli Hastalarda İnsülin Tedavisi İçin Riskli Grubun Belirlenmesi

Öz

Amaç: Bu çalışmanın amacı üçüncü basamak bir hastanenin endokrin polikliniğine başvuran gestasyonel diyabetes mellitus (GDM)
tanılı hastaların antenatal insülin tedavisini (AIT) predikte eden değişkenleri tespit etmektir.
Gereç ve Yöntemler: Çalışmaya GDM tanılı 619 hasta dahil edildi. İnsülin kullanan ve kullanmayan iki grubun oral glukoz tolerans testi
(OGTT), HbA1C, lipid düzeyleri ve diğer biyokimyasal ölçümleri Mann-Whitney U veya Student t-testi ile karşılaştırıldı. Bu gruplar
arasındaki demografik özellikler, obezite, HbA1c (%) ve diyete uyum Ki Kare testi ile karşılaştırıldı. Üç insülin grubu (bazal, bolus veya
her ikisini kullanan) arasındaki OGTT-75 ölçümleri ANOVA ile karşılaştırıldı.
Bulgular: Çalışmamıza dahil edilen GDM’li hastaların %27.0’sinde insülin ihtiyacı olmuştur. İnsülin grubunda; obez, morbid obez ve
düşük diyet uyumu olan hasta oranı, ayrıca OGTT-75 0-s glukoz, 2-s glukoz, HbA1c (%) ve trigliserid ölçümleri MNT grubuna göre
anlamlı olarak yüksek bulundu. OGTT-75' de üç ölçüm değerinin birden kesme değerin üstünde olması insülin ihtiyacı ile ilişkiliydi.
OGTT-75 2-s glukoz değeri > 151.5 mg/dL (% 68.4 sensivite, % 60.0 spesifite) olması insülin ihtiyacını genel olarak predikte ederken, 0-s
glukoz değerinin> 95.0 mg/dL (% 72.0 sensivite, %69.0 spesifite) olması bazal AIT ihtiyacını predikte etti.
Sonuç: GDM’de tanı ile birlikte insülin tedavisi için riskli grubun belirlenmesini öneriyoruz. İnsülin tedavisi için risk grubunda bulunan
hastalarda daha yakın takip gereklidir.

Anahtar Kelimeler

Gestasyonel diyabetes mellitus, Oral glukoz tolerans testi, İnsülin, Nutrisyon, Trigliserid, Glukoz

Kaynakça

• 1. Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglycaemia in pregnancy. Diabetes Res Clin Pract. 2014;103(2):176-185.
• 2. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018;131(2):e49-e64.
• 3. ACOG Practice Bulletin No. 201: Pregestational Diabetes Mellitus. Obstet Gynecol. 2018;132:e228-e248.
• 4. American Diabetes Association. 14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S200-S210.
• 5. The Socıety of Endocrınology and Metabolısm of Turkey. Clinical Practice Guideline for Diagnosis, Treatment and Follow-up of Diabetes Mellitus and Its Complications - 2019. 178-183(12th Edition)
• 6. Harrison RK, Cruz M, Wong A, Davitt C, Palatnik A. The timing of initiation of pharmacotherapy for women with gestational diabetes mellitus. BMC Pregnancy Childbirth. 2020;20(1):773.
• 7. Asiedu-Danso M, Kretchy IA, Sekyi JK, Koduah A. Adherence to antidiabetic medications among women with gestational diabetes. J Diabetes Res. 2021;2021:9941538.
• 8. Sarbacker GB, Urteaga EM. Adherence to insulin therapy. Diabetes Spectr. 2016;29(3):166-170.
• 9. Benhalima K, Robyns K, Van Crombrugge P, Deprez N, Seynhave B, Devlieger R, Verhaeghe J, Mathieu C, Nobels F. Differences in pregnancy outcomes and characteristics between insulin- and diet-treated women with gestational diabetes. BMC Pregnancy Childbirth. 2015;15:271.
• 10. Bakiner O, Bozkirli E, Ozsahin K, Sariturk C, Ertorer E. Risk factors that can predict antenatal insulin need in gestational diabetes. J Clin Med Res. 2013;5:381-388.
• 11. Cheng YW, Chung JH, Kurbisch-Block I, Inturrisi M, Shafer S, Caughey AB. Gestational weight gain and gestational diabetes mellitus: Perinatal outcomes. Obstet Gynecol. 2008;112(5):1015-1022.
• 12. World Health Organization. WHO fact sheet on overweight and obesity. Updated October 2017. (Accessed December 8, 2017, at http://www.who.int/mediacentre/factsheets/fs311/ en/.)
• 13. Cohen J. Statistical power analysis for the behavioral sciences, 2th Edition, New York, Routledge, 1998.
• 14. Society of Maternal-Fetal Medicine (SMFM) Publications Committee. Electronic address: [e-mail]. SMFM Statement: Pharmacological treatment of gestational diabetes. Am J Obstet Gynecol. 2018;218(5):B2-B4.
• 15. Mitra S, Nayak PK, Sahoo J, Mathew A, Padma A, Kamalanathan S, Agrawal S. Predictors for antenatal insulin requirements in gestational diabetes. Gynecol Endocrinol. 2014;30:565-568.
• 16. Juutinen J, Hartikainen AL, Bloigu R, Tapanainen JS. A retrospective study on 435 women with gestational diabetes: Fasting plasma glucose is not sensitive enough for screening but predicts a need for insulin treatment. Diabetes Care. 2000;23:1858-1859.
• 17. Zhang Y, Shao J, Li F, Xu X. Factors in gestational diabetes mellitus predicting the needs for insulin therapy. Int J Endocrinol. 2016;2016:4858976.
• 18. Eleftheriades M, Chatzakis C, Papachatzopoulou E, Papadopoulos V, Lambrinoudaki I, Dinas K, Chrousos G, Sotiriadis A. Prediction of insulin treatment in women with gestational diabetes mellitus. Nutr Diabetes. 2021;11(1):30.
• 19. Yanagisawa K, Muraoka M, Takagi K, Ichimura Y, Kambara M, Sato A, Sakura H, Uchigata Y. Assessment of predictors of insulin therapy in patients with gestational diabetes diagnosed according to the IADPSG criteria. Diabetol Int. 2016;7(4):440- 446.
• 20. Weschenfelder F, Lohse K, Lehmann T, Schleußner E, Groten T. Predictors of treatment requirements in women with gestational diabetes: A retrospective analysis. J Clin Med. 2021;10(19):4421.
• 21. Tang L, Xu S, Li P, Li L. Predictors of insulin treatment during pregnancy and abnormal postpartum glucose metabolism in patients with gestational diabetes mellitus. Diabetes Metab Syndr Obes. 2019;12:2655-2665.
• 22. Gruendhammer M, Brezinka C, Lechleitner M. The number of abnormal plasma glucose values in the oral glucose tolerance test and the feto-maternal outcome of pregnancy. Eur J Obstet Gynecol Reprod Biol. 2003;108(2):131-136.
• 23. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352:2477e86.
• 24. Hartling L, Dryden DM, Guthrie A, Muise M, Vandermeer B, Donovan L. Benefits and harms of treating gestational diabetes mellitus: A systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med. 2013;159(2):123-129.
• 25. Ryckman KK, Spracklen CN, Smith CJ, Robinson JG, Saftlas AF. Maternal lipid levels during pregnancy and gestational diabetes: A systematic review and meta-analysis. BJOG. 2015;122(5):643-651.
• 26. Hu J, Gillies CL, Lin S, Stewart ZA, Melford SE, Abrams KR, Baker PN, Khunti K, Tan BK. Association of maternal lipid profile and gestational diabetes mellitus: A systematic review and meta-analysis of 292 studies and 97,880 women. E Clinical Medicine. 2021;34:100830.
• 27. Di Cianni G, Seghieri G, Lencioni C, Cuccuru I, Anichini R, De Bellis A, Ghio A, Tesi F, Volpe L, Del Prato S. Normal glucose tolerance and gestational diabetes mellitus: What is in between? Diabetes Care. 2007;30(7):1783-1788.
• 28. Wong VW, Jalaludin B. Gestational diabetes mellitus: Who requires insulin therapy? Aust NZ J Obstet Gynaecol. 2011;51:432-436.