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Predictive factors of subsequent insulin requirement for glycemic control during pregnancy at diagnosis of gestational diabetes mellitus
Author(s) -
Ducarme Guillaume,
Desroys du Roure François,
Grange Joséphine,
Vital Mathilde,
Le Thuaut Aurélie,
CrespinDelcourt Ingrid
Publication year - 2019
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12753
Subject(s) - medicine , glycemic , gestational diabetes , glycated hemoglobin , odds ratio , diabetes mellitus , area under the curve , obstetrics , youden's j statistic , pregnancy , logistic regression , receiver operating characteristic , prospective cohort study , insulin , gestation , endocrinology , type 2 diabetes , biology , genetics
Objective To determine maternal and biological parameters at diagnosis of gestational diabetes mellitus ( GDM ) as predictors of antenatal insulin therapy ( AIT ) for glycemic control. Methods In this planned secondary analysis of a prospective observational study, we recruited women diagnosed with GDM between July 1, 2014, and October 31, 2015. Maternal and biological parameters were analyzed as predictors of AIT using multivariable logistic regression analyses. Predictive accuracy of a cut‐off value for a biological predictor was determined using the area under the receiver operating characteristic curve ( AUC ) and the Youden index (J). Results Of 200 women included (mean gestational age 22 ± 6 weeks), 72 (36%) required AIT . No maternal characteristic was associated with AIT . Glycated hemoglobin (HbA1c; adjusted odds ratio [ aOR ] 3.15, 95% CI 1.03–9.69) and elevated 1‐hour oral glucose tolerance test ( OGTT ; aOR 1.23, 95% CI 1.13–1.46) were predictors of AIT . Analyses suggested inaccurate prediction of AIT , with an optimal cut‐off HbA1c value of 5.4% (J=0.14; AUC 0.58, 95% CI 0.48–0.67), and an optimal 1‐hour plasma glucose OGTT value of 1.77 mg/ dL (J=0.24; AUC 0.62, 95% CI 0.50–0.74). Conclusion HbA1c at diagnosis of GDM and elevated 1‐hour OGTT were independent predictors of AIT for glycemic control. Clinicaltrials.gov: NCT 02159378.