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 fasting, 1, and 2 hours, but not at 3 hours after glucose loading and higher rate of abnormal fasting plasma glucose values and higher number of abnormal OGTT values. Logistic regression analysis showed that independent associated factors for insulin requirement were fasting plasma glucose (FPG) at OGTT > 95 mg/dL (adjusted odds ratio (OR) 20.8, 95% confidence interval (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 1.2-3.9). While other pregnancy outcomes were comparable between the 2 groups, infants of cases were significantly more likely to have neonatal hypoglycemia and need for 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

References

American College of Obstetricians and Gynecologists. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 190: Gestational diabetes mellitus. Obstet Gynecol 2018;131:e49-64.

American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2018;41(Suppl 1):S13-27.

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.

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;352:2477-86.

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;159:123-9.

Szmuilowicz ED, Josefson JL, Metzger BE. Gestational Diabetes Mellitus. Endocrinol Metab Clin North Am 2019;48:479-93.

Mukerji G, Feig DS. Pharmacological Management of Gestational Diabetes Mellitus. Drugs 2017;77:1723-32.

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.

Ketumarn N, Boriboonhirunsarn D. Characteristics of abnormal oral glucose tolerance test in GDM diagnosis and clinical correlation. J Matern Fetal Neonatal Med 2018;31:2109-14.

Souza A, 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 2019;32:2036-41.

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;82:219-25.

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;88:81-6.

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;5:381-8.

Wong VW, Jalaludin B. Gestational diabetes mellitus: who requires insulin therapy? Aust N Z J Obstet Gynaecol 2011;51:432-6.

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.

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;86:708-14.

Rasmussen KM, Yaktine AL, editors. Weight gain during pregnancy: Reexamining the guidelines. Washington, DC: The National Academies Press; 2009.

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.

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;59:1403-11.

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;144:265-70.