title: Risk Factors That can Predict Antenatal Insulin Need in Gestational Diabetes.
abstract: BACKGROUND
  This study was undertaken to assess the association between insulin need in gestational diabetes mellitus (GDM) and clinical features and laboratory parameters. Factors that can predict insulin need are also identified.
  
  
  METHODS
  Cases with GDM were included retrospectively from records. Cases which failed to achieve target blood glucose levels with medical nutrition therapy (MNT) and need insulin treatment were recorded. Risk factors which can predict antenatal insulin treatment (AIT) were identified as follows; the presence of diabetes in a first degree relative, body mass index prior to pregnancy, number of parity, history of GDM, macrosomic baby delivery (> 4,000 g), age, gestational week at time of diagnosis, body mass index during diagnosis, weight gain untill diagnosis, mean systolic and diastolic blood pressure, HbA1C level during diagnosis, and fasting plasma glucose on diagnostic oral glucose tolerance test. Presence of a statistical significance between those patient features and AIT was assessed. Independent predictors for AIT were evaluated.
  
  
  RESULTS
  A total of 300 cases were recruited from records, 190 cases (63.3%) were followed only with MNT until delivery and 110 cases (36.7%) were initiated AIT. The association between AIT and patient factors like presence of diabetes in the pedigree, week of gestation at which GDM was diagnosed, BMI during diagnosis, HbA1C levels, and fasting plasma glucose during diagnosis was found (P = 0.03; 0.008; 0.049; 0.001 and 0.001respectively). Multivariant analysis showed that fasting plasma glucose levels during diagnosis and HbA1C levels were independent risk factors for AIT. Fasting plasma glucose values that can predict AIT were identified > 89.5 mg/dL with 72.7% sensitivity and 62.6% spesifity (P < 0.001). Positive predictive value was 73% (P < 0.001). Also, HbA1C levels that can predict AIT was found to be > 5.485% with 65.3% sensitivity and 66.7% spesifitiy(P < 0.001) with a positive predictive value 68% (P < 0.001).
  
  
  CONCLUSIONS
  Independent predictors for AIT were found as fasting plasma glucose on OGTT and HbA1c levels during diagnosis in GDM. Cases with fasting plasma glucose ≥ 89.5 mg/dL or HbA1C ≥ 5.485% should be closely followed for AIT in specified centers.
authors: Department of Endocrinology and Metabolism Diseases, Baskent University, Faculty of Medicine, Turkey.
authors: Okan
authors: O
authors: Bakiner
authors: Emre
authors: E
authors: Bozkirli
authors: Kursat
authors: K
authors: Ozsahin
authors: Cagla
authors: C
authors: Sariturk
authors: Eda
authors: E
authors: Ertorer
keywords: Antenatal; Diabetes mellitus; Gestational; Insulin; Risk factors
references: N Engl J Med. 2005 Jun 16;352(24):2477-86
references: 15951574
references: N Engl J Med. 2008 May 8;358(19):1991-2002
references: 18463375
references: J Womens Health (Larchmt). 2008 Sep;17(7):1183-7
references: 18774897
references: Curr Diab Rep. 2010 Jun;10(3):229-34
references: 20425587
references: Diabetes Care. 2007 Jul;30 Suppl 2:S251-60
references: 17596481
references: Diabetes Care. 2007 Jul;30(7):1783-8
references: 17416793
references: Diabetes Res Clin Pract. 2007 Sep;77(3):465-70
references: 17350135
references: Endocr Pract. 2012 Jan-Feb;18(1):62-5
references: 21856598
references: Diabetes Care. 2000 Dec;23(12):1858-9
references: 11128372
references: Diabetes Care. 1998 Aug;21 Suppl 2:B91-8
references: 9704234
references: J Clin Endocrinol Metab. 2001 Mar;86(3):989-93
references: 11238474
references: Diabetes Care. 2011 Jan;34 Suppl 1:S11-61
references: 21193625
references: Diabetes Res Clin Pract. 2007 Aug;77(2):174-9
references: 17234297
references: Diabetes Care. 2007 Jul;30 Suppl 2:S220-4
references: 17596476
references: Am J Med. 2005 Sep;118(Suppl 9A):27S-32S
references: 16224940
references: Diabetes Res Clin Pract. 2008 Nov;82(2):219-25
references: 18768235
references: Obstet Gynecol. 1999 Jun;93(6):978-82
references: 10362166
references: Diabetes Care. 2008 Jan;31 Suppl 1:S12-54
references: 18165335
references: Am J Obstet Gynecol. 2002 Feb;186(2):204-9
references: 11854636
references: Diabetes Res Clin Pract. 2010 Apr;88(1):81-6
references: 20071050
references: Am J Obstet Gynecol. 1994 Apr;170(4):1036-46; discussion 1046-7
references: 8166187
references: Aust N Z J Obstet Gynaecol. 2010 Oct;50(5):439-43
references: 21039377