medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2020, Number 11

<< Back Next >>

Ginecol Obstet Mex 2020; 88 (11)

Prediction of insulin treatment in patients with gestational mellitus diabetes

Méndez-Míguez I, Álvarez-Silvares E, Rubio-Cid P, Castro-Vilar L, Seoane-Pillado T

Language: Spanish
References: 30
Page: 745-755
PDF size: 235.48 Kb.


ABSTRACT

Objective: To determine the risk factors for requiring insulin treatment in women with gestational diabetes.
Materials and Methods: Observational, case-control, prospective, nested study in a cohort of patients with gestational diabetes. To determine the variables associated or not with the probability of requiring insulin treatment, a multivariate logistic regression analysis was performed. It was studied the discriminatory capacity of glucose and glycosylated hemoglobin basal concentrations, according to the need of treatment with insulin through the analysis of ROC curves; the area under the curve was estimated. With the Youden Index, the optimal cut-off point was calculated.
Results: 113 patients diagnosed with gestational diabetes mellitus were studied, of which 27.4% (n = 31) required insulin treatment for glycemic control (case group); 72.6% (n = 82) achieved good metabolic control with diet and exercise (control group). The predictors of the need for insulin treatment were history of previous gestational diabetes, body mass index at the beginning of pregnancy, diagnosis of gestational diabetes before the third trimester, basal glycemia on the glucose tolerance curve and the value of glycosylated hemoglobin. The discriminating ability of basal glycaemia, by ROC curve analysis, had a C-statistic of 0.822 and for glycosylated hemoglobin of 0.718. Basal glycemia greater than 90 mg/dL predicted the need for insulin treatment with a sensitivity of 93.1% and specificity of 65.43%. Glycosylated hemoglobin value greater than 5% predicted the likelihood of insulin treatment with sensitivity of 93.3% and specificity of 41.4%.
Conclusions: When diagnosing gestational diabetes, it is possible to select a group of pregnant women with a higher risk of needing medical treatment.


REFERENCES

  1. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997; 20: 1183-97. doi: 10.2337/diacare.20.7.1183

  2. American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes, 2019. Diabetes Care 2019; 42 (Supplement 1): S13-S28. https://doi.org/10.2337/dc19-S002

  3. Guariguata L, et al. Global estimates of the prevalence of hyperglycemia in pregnancy. Diabetes Res Clin Pract. 2014; 103 (2): 176-85. doi. 10.1016/j.diabres.2013.11.003.

  4. Sacks DA, et al. HAPO Study Cooperative Research Group. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care 2012; 35 (3): 526-8. doi: 10.2337 / dc11-1641.

  5. American Diabetes Association. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes, 2018. Diabetes Care. 2018; 41 (Suppl 1): S137‐S143. doi:10.2337/ dc18-S013

  6. Nishikawa T, et al. One-hour oral glucose tolerance test plasma glucose at gestational diabetes diagnosis is a common predictor of the need for insulin therapy in pregnancy and postpartum impaired glucose tolerance. J Diabetes Investig. 2018; 9 (6): 1370-77. doi: 10.1111/jdi.12848

  7. Ares J, et al. Gestational Diabetes Mellitus (GDM): Relationship between Higher Cutoff Values for 100g Oral Glucose Tolerance Test (OGTT) and Insulin Requirement during Pregnancy. Matern Child Health J. 2017; 21 (7): 1488-92. doi: 10.1007/s10995-017-2269-0.

  8. HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations with neonatal anthropometrics. Diabetes. 2009; 58 (2): 453‐59. doi. 10.2337/db08-1112

  9. Waters TP, et al. Maternal and Neonatal Morbidity for Women Who Would Be Added to the Diagnosis of GDM Using IADPSG Criteria: A Secondary Analysis of the Hyperglycemia and Adverse Pregnancy Outcome Study. Diabetes Care. 2016; 39 (12): 2204‐10. doi:10.2337/dc16-1194

  10. Domínguez-Vigo P, et al. Implicaciones del diagnóstico de diabetes gestacional en la salud futura de la mujer. Ginecol Obstet Mex. 2016; 84 (12): 775-84.

  11. Szmuilowicz ED, et al. Diabetes mellitus gestational. Endocrinol Metab Clin North Am. 2019; 48 (3): 479‐93. doi: 10.1016 / j.ecl.2019.05.001

  12. Vandorsten JP, et al. NIH consensus development conference: diagnosing gestational diabetes mellitus. NIH Consens State Sci Statements 2013; 29: 1-31

  13. Grupo Español de Diabetes y Embarazo (GEDE). Documento de consenso. Guía asistencial de diabetes mellitus y embarazo. Av Diabetol 2006; 22: 73-87. http://www. avancesendiabetologia.org/gestor/upload/revistaAvances/ 22-1-7.pdf

  14. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes. 1979; 28 (12): 1039-57. doi:10.2337/ diab.28.12.1039

  15. Hartling L, et al. 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): 123-9. doi: 10.7326/0003-4819-159-2-201307160-00661.

  16. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018; 131 (2): e49-e64. doi: 10.1097/ AOG.0000000000002501.

  17. Souza ACRLA, et al. Can we stratify the risk for insulin need in women diagnosed early with gestational diabetes by fasting blood glucose? J Matern Fetal Neonatal Med. 2019; 32 (12): 2036-41. doi:10.1080/14767058.2018.1424820

  18. Bakiner O, et al. Risk Factors That can Predict Antenatal Insulin Need in Gestational Diabetes. J Clin Med Res. 2013; 5 (5): 381-88. doi:10.4021/jocmr1515w

  19. Yerlikaya G, et al. To Predict the Requirement of Pharmacotherapy by OGTT Glucose Levels in Women with GDM Classified by the IADPSG Criteria. J Diabetes Res. 2018; 2018: 3243754. doi: 10.1155/2018/3243754.

  20. Barnes RA, et al. A novel validated model for the prediction of insulin therapy initiation and adverse perinatal outcomes in women with gestational diabetes mellitus. Diabetologia. 2016; 59 (11): 2331-38. doi: 10.1007/ s00125-016-4047-8.

  21. Aktun LH, et al. Predictive Risk Factors in the Treatment of Gestational Diabetes Mellitus. Clin Med Insights Womens Health. 2015; 8: 25-8. doi: 10.4137/CMWH.S31564.

  22. Sapienza AD, et al. Factors predicting the need for insulin therapy in patients with gestational diabetes mellitus. Diabetes Res Clin Pract. 2010; 88 (1): 81-6. doi: 10.1016/j. diabres.2009.12.023.

  23. Álvarez Ballano D, et al. Factores predictivos de insulinización en diabetes gestacional. Av Diabetol 2006; 22: 88-93. http://www.avancesendiabetologia.org/gestor/upload/ revistaavances/22-1-8.pdf

  24. Akinci B, et al. Is fasting glucose level during oral glucose tolerance test an indicator of the insulin need in gestational diabetes? Diabetes Res Clin Pract. 2008; 82 (2): 219-25. doi: 10.1016/j.diabres.2008.07.023.

  25. Ducarme G, et al. Efficacy of maternal and biological parameters at the time of diagnosis of gestational diabetes mellitus in predicting neonatal morbidity. Eur J Obstet Gynecol Reprod Bio. 2018; 221: 113-18. doi: 10.1016 / j.ejogrb.2017.12.036.

  26. Wong VW, Jalaludin B. Gestational diabetes mellitus: who requires insulin therapy? Aust N Z J Obstet Gynaecol. 2011; 51 (5): 432-6. doi: 10.1111/j.1479-828X.2011.01329.x.

  27. Koning SH, et al. Risk stratification for healthcare planning in women with gestational diabetes mellitus. Neth J Med. 2016; 74 (6): 262-9. http://www.njmonline.nl/getpdf. php?id=1736

  28. Pertot T, et al. Can common clinical parameters be used to identify patients who will need insulin treatment in gestational diabetes mellitus? Diabetes Care. 2011; 34 (10): 2214-16. doi:10.2337/dc11-0499

  29. Durnwald C. (2020). Gestational diabetes mellitus: Glycemic control and maternal prognosis. Nathan DM, Werner EF (Ed.), UpToDate. (Revisado el 01/06/2020). https//:uptodate.com.

  30. Matsumoto Y, et al. Background factors determining the introduction and dosage of insulin in women with gestational diabetes mellitus. J Clin Med Res. 2019; 11 (6): 447-51. doi: 10.14740/jocmr3824.




2020     |     www.medigraphic.com