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

Yıl 2022, Cilt: 6 Sayı: 1, 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

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