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Using Glucose Tolerance Test Results to Predict Insulin Requirement in Women with Gestational Diabetes
Author(s) -
Tan Y.Y.,
Liauw P.C.Y.,
Yeo G.S.H.
Publication year - 1995
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1995.tb01977.x
Subject(s) - gestational diabetes , medicine , insulin , glucose tolerance test , diabetes mellitus , gestation , endocrinology , blood sugar , glucose test , fasting blood sugar , pregnancy , insulin resistance , biology , genetics
EDITORIAL COMMENT: This paper shows that the blood glucose values recorded in the glucose tolerance test which resulted in the diagnosis of gestational diabetes do not reliably predict which women will require insulin when dietary measures fail. It is not surprising that, in this study, the 2‐hour glucose value correlated best with the need for insulin therapy since gestational diabetes was diagnosed solely on the basis of a high 2‐hour glucose value (≥ 7.8 mmol/L). The data from the 596 women with gestational diabetes shown in the tables and figures should especially interest readers who manage women with gestational diabetes. In many centres women with gestational diabetes are managed without admission to hospital. Attendance at a day centre after initial diagnosis is helpful to arrange instruction from a diabetes educator and dietitian, including instruction regarding home monitoring of blood glucose levels in those where this seems necessary. In the clinics which the editorial subcommittee attend, insulin is commenced in women with gestational diabetes when the 2‐hour postprandial plasma glucose level exceeds 6.5 mmol/L on 2 or more occasions, in spite of dietary measures. In this clinic women with gestational diabetes seldom require hospitalization for stabilization of blood glucose levels. Figures 1–3 clearly show that although insulin therapy is more likely to be indicated when fasting, 1‐hour or 2‐hour plasma values are high, there are many women with high values at these points on the glucose tolerance test resulting in diagnosis of gestational diabetes, who did not require insulin. Patient compliance with dietary advice is the one explanation of this finding which the clinician is most likely to be able to influence. Summary: This study was done to test the clinical impression that the result of the oral glucose tolerance test could be used to predict which patients with gestational diabetes did not need insulin therapy. If this was true, a full blood sugar profile assessment could be avoided in many of these women. The second analysis was to test the clinical impression that the fasting glucose level was the best predictor of insulin requirement in women with gestational diabetes. The results of the study showed that none of the 3 readings of the oral glucose tolerance test could be used to predict reliably which patients did not need insulin therapy. Hence, blood sugar profile assessment of all patients with gestational diabetes is still necessary. The receiver‐operator characteristic curves also showed that the 2‐hour postload glucose level during the 75 g load glucose tolerance test was a better predictor of insulin requirement than the fasting glucose level.