title: Antenatal factors predicting subsequent need for insulin treatment in women with gestational diabetes.
abstract: OBJECTIVE
  To identify characteristics indicative of subsequent requirement of insulin in patients with gestational diabetes (GDM).
  
  
  METHODS
  Identified from a database were patients with GDM not receiving insulin or oral hypoglycemic agents at enrollment for outpatient education and surveillance. Maternal characteristics were compared between patients achieving glycemic control with diet and those requiring insulin. Cox proportional hazards regression was used to assess multiple effects of significant univariate factors.
  
  
  RESULTS
  Data from 2365 patients were analyzed. Patients requiring insulin were more likely to be multiparous, obese, have a history of GDM, be diagnosed at <28 weeks of gestation, and have a fasting blood glucose of >95 mg/dL, a glucose tolerance test 3-hour blood glucose of >140 mg/dL, and a glycosylated hemoglobin (A1c) of >or=6% at diagnosis of GDM.
  
  
  CONCLUSIONS
  Laboratory values at diagnosis of GDM were the strongest indicators of subsequent need for insulin treatment. Patients with fasting blood glucose of >95 mg/dL and A1c values >or=6% at diagnosis of GDM should receive close surveillance of daily blood glucose.
authors.affiliation: University of Miami, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Miami, Florida 33101, USA. vhgonzalez@med.miami.edu
authors.forename: Víctor Hugo
authors.initials: VH
authors.lastname: González-Quintero
authors.forename: Niki B
authors.initials: NB
authors.lastname: Istwan
authors.forename: Debbie J
authors.initials: DJ
authors.lastname: Rhea
authors.forename: Carmen Maria
authors.initials: CM
authors.lastname: Tudela
authors.forename: Amy Alicia
authors.initials: AA
authors.lastname: Flick
authors.forename: Lesley
authors.initials: L
authors.lastname: de la Torre
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Stanziano
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D016208:Databases, Factual; D016640:Diabetes, Gestational / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy*; D003927:Diet, Diabetic / Q000706:statistics & numerical data; D005260:Female; D005845:Georgia; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D009765:Obesity; D010298:Parity; D011247:Pregnancy
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin