title: Can common clinical parameters be used to identify patients who will need insulin treatment in gestational diabetes mellitus?
abstract: OBJECTIVE
  To identify patients with gestational diabetes mellitus (GDM) who will need antenatal insulin treatment (AIT) by using a risk-prediction tool based on maternal clinical and biochemical characteristics at diagnosis.
  
  
  METHODS
  Data from 3,009 women attending the Royal Prince Alfred Hospital GDM Clinic, Australia, between 1995 and 2010 were studied. A risk engine was developed from significant factors identified for AIT using a logistic regression model.
  
  
  RESULTS
  A total of 51% of GDM patients required AIT. Ethnicity, gestation at diagnosis, HbA(1c), fasting and 60-min glucose at oral glucose tolerance test, BMI, and diabetes family history were significant independent determinants of AIT. Notably, only 9% of the attributable risk for AIT can be explained by the clinical factors studied. A modeled risk-scoring system was therefore a poor predictor of AIT.
  
  
  CONCLUSIONS
  Baseline maternal characteristics including HbA(1c) alone cannot predict the need for AIT in GDM. Lifestyle, compliance, or as yet unmeasured influences play a greater role in determining AIT.
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Tania
authors.initials: T
authors.lastname: Pertot
authors.forename: Lynda
authors.initials: L
authors.lastname: Molyneaux
authors.forename: Kris
authors.initials: K
authors.lastname: Tan
authors.forename: Glynis P
authors.initials: GP
authors.lastname: Ross
authors.forename: Dennis K
authors.initials: DK
authors.lastname: Yue
authors.forename: Jencia
authors.initials: J
authors.lastname: Wong
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008019:Life Style; D010349:Patient Compliance; D011247:Pregnancy
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin