Risk Factors for Insulin Therapy in Gestational Diabetes Mellitus

Main Article Content

Sriwipa Kaewsrinual
Dittakarn Borriboonhiransan

Abstract

Objectives: To determine the factors associated with insulin requirement in patients with gestational diabetes mellitus (GDM) and compare the obstetrics outcomes between those who required insulin therapy and who did not.


Materials and methods: A case-control study was conducted, including 100 GDM women who required insulin therapy as cases and 400 GDM women who did not require insulin therapy as controls. Data on baseline and obstetric characteristics, antenatal care, GDM risks, screening and diagnostic test results, labor and delivery, and obstetrics outcomes were reviewed from the medical records.


Results: Cases were significantly more likely to be nulliparous, overweight or obese, have DM in family, have had prior GDM, had higher number of GDM risks than controls. Compared with controls, cases had significantly higher plasma glucose level at every measurement of 100-g OGTT and had abnormal fasting and 1-hour plasma glucose values and higher number of abnormal OGTT values. Logistic regression analysis showed that independent associated factors for insulin requirement were FPG at OGTT >95 mg/dL (adjusted OR 20.8, 95%CI 11.4-37.9), overweight or obesity (adjusted OR 1.9, 95%CI 1.1-3.5) and family history of DM (adjusted OR 2.2, 95%CI 1.3-3.9). While other pregnancy outcomes were comparable between the 2 groups, infants of cases were significantly more likely to have neonatal hypoglycemia and need of phototherapy.


Conclusion: Independent associated risks for insulin therapy in GDM women included FPG of >95 mg/dL at OGTT, overweight or obesity, and family history of DM.

Downloads

Download data is not yet available.

Article Details

Section
Original Article
Author Biography

Dittakarn Borriboonhiransan, Siriraj Hospital, Bangkok

References

1. American College of Obstetricians and Gynecologists. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 190: Gestational diabetes mellitus. Obstet Gynecol. 2018;131(2):e49-64.
2. American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2020;43(Suppl 1):S14-31.
3. Boriboonhirunsarn D, Talungjit P, Sunsaneevithayakul P, Sirisomboon R. Adverse pregnancy outcomes in gestational diabetes mellitus. J Med Assoc Thai. 2006;89 Suppl 4:S23-8.
4. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352(24):2477-86.
5. 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):123-9.
6. Szmuilowicz ED, Josefson JL, Metzger BE. Gestational Diabetes Mellitus. Endocrinol Metab Clin North Am. 2019;48(3):479-93.
7. Mukerji G, Feig DS. Pharmacological Management of Gestational Diabetes Mellitus. Drugs. 2017;77(16):1723-32.
8. Brown J, Grzeskowiak L, Williamson K, Downie MR, Crowther CA. Insulin for the treatment of women with gestational diabetes. Cochrane Database Syst Rev. 2017;11:CD012037.
9. Ketumarn N, Boriboonhirunsarn D. Characteristics of abnormal oral glucose tolerance test in GDM diagnosis and clinical correlation. J Matern Fetal Neonatal Med. 2018;31(16):2109-14.
10. Souza ACRLA, Costa RA, Paganoti CF, Rodrigues AS, Zugaib M, Hadar E, 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. 2018:1-6.
11. Akinci B, Celtik A, Yener S, Yesil S. 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.
12. Sapienza AD, Francisco RP, Trindade TC, Zugaib M. Factors predicting the need for insulin therapy in patients with gestational diabetes mellitus. Diabetes Res Clin Pract. 2010;88(1):81-6.
13. 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(5):381-8.
14. Wong VW, Jalaludin B. Gestational diabetes mellitus: who requires insulin therapy? Aust N Z J Obstet Gynaecol. 2011;51(5):432-6.
15. 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.
16. Sunsaneevithayakul P, Boriboohirunsarn D, Sutanthavibul A, Ruangvutilert P, Kanokpongsakdi S, Singkiratana D, et al. Risk factor-based selective screening program for gestational diabetes mellitus in Siriraj Hospital: result from clinical practice guideline. J Med Assoc Thai. 2003;86(8):708-14.
17. Moosazadeh M, Asemi Z, Lankarani KB, Tabrizi R, Maharlouei N, Naghibzadeh-Tahami A, et al. Family history of diabetes and the risk of gestational diabetes mellitus in Iran: A systematic review and meta-analysis. Diabetes Metab Syndr. 2017;11 Suppl 1:S99-S104.
18. Rayanagoudar G, Hashi AA, Zamora J, Khan KS, Hitman GA, Thangaratinam S. Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women. Diabetologia. 2016;59(7):1403-11.
19. Ducarme G, Desroys du Roure F, Grange J, Vital M, Le Thuaut A, Crespin-Delcourt I. Predictive factors of subsequent insulin requirement for glycemic control during pregnancy at diagnosis of gestational diabetes mellitus. Int J Gynaecol Obstet. 2019;144(3):265-70.