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

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

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