Faculty of Medicine
Library of the School of Health Sciences

2021-08-20

2021

Papachatzopoulou Eftychia

Χρούσος Γεώργιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Πανουλής Κων/νος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Βλάχος Νικόλαος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Λαμπρινουδάκη Ειρήνη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ελευθεριάδης Μακάριος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Περβανίδου Παναγιώτα, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Πάσχου Σταυρούλα, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ

Μεταβολικοί και βιοχημικοί προβλεπτικοί δείκτες για χρήση ινσουλίνης σε σακχαρώδη διαβήτη κύησης

Greek

Metabolic and biochemical predictors of insulin treatment in gestational diabetes mellitus

Aims: This study aimed to investigate whether pregnancies complicated by gestational diabetes mellitus (GDM) present differences in the outcomes according to the findings on oral glucose tolerance test (OGTT), including fasting, post-load or combined abnormal blood glucose.
Materials: This was a prospective cohort study including 831 singleton pregnancies with GDM per the IADPSG criteria. According to their fasting blood glucose value on OGTT the women were categorized in three groups: (i) GDM women with fasting plasma glucose levels > 92 mg/dl and normal post-load values (T0 abnormal group), (ii) patients with abnormal values at 60 min and/or 120 min and normal fasting values (T-post group) and (iii) patients with combined fasting and post-load abnormal blood glucose values (T-comb). Regression analysis was used to test the independent contribution of the different groups, along with maternal and fetal characteristics, in prediction of (i) large for gestational age (LGA), (ii) need for insulin treatment and (iii) birthweight centile.
Results: GDM with abnormal fasting blood glucose was an independent risk factor for LGA (OR 2.91, 95% CI 1.33–6.36) and was associated with higher birthweight centile (10.25, 95% CI 0.27–20.25). GDM with combined fasting and post-load abnormal blood glucose was an independent risk factor for insulin treatment (OR 2.94, 95% CI 1.93–4.47).
Conclusions: Women with GDM and abnormal fasting blood glucose are at increased risk for large for gestational age neonates, while women with GDM and combined fasting and postload abnormal blood glucose are at increased risk for insulin therapy.
Introduction: The identification of pregnant women with Gestational Diabetes Mellitus (GDM) who will require insulin therapy, may modify their management to closer monitoring and probable early interventions. The aim of the study was to develop a predictive model for the necessity of insulin treatment in women with GDM.
Materials and methods: This was a prospective cohort study. Data from 775 women diagnosed with GDM per the IADPSG criteria were analyzed using logistic regression and a machine learning algorithm, the Classification and Regression Trees (CART). Potential predictors routinely recorded at follow-up visits were tested and used for the development of the model. The resultant model was externally validated using the data from two different perinatology clinics.
Results: Preconceptional maternal BMI and morning fasting blood glucose levels at baseline and at 1 hour during an Oral Glucose Tolerance Test (OGTT) were independent significant predictors for the treatment modality of GDM. Baseline blood glucose greater than 98 mg/dl and preconceptional maternal Body Mass Index (BMI) between 26 and 31 kg/height2 increased substantially the probability of insulin therapy (odds ratio [OR] 4.04, 95% confidence interval [CI] CI 2.65-6.17 and 2.21, 95% CI 1.42-3.43, respectively). The area under the curve (AUC) for the internal and external validation of the predictive model was 0.74 and 0.77, respectively.
Conclusions: A simple model based on maternal characteristics and the values of an OGTT can predict the need for insulin treatment with accuracy. Overweight women with abnormal baseline blood glucose at OGTT are at high likelihood for insulin treatment.

Health Sciences

gestational diabetes mellitus, insulin, predictors

No

0

Yes

420

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https://pergamos.lib.uoa.gr/uoa/dl/object/2959672