Abstract
Objectives To study if there is any relationship about higher cutoff values for 100 g oral glucose tolerance test and the need for insulin in women diagnosed with gestational diabetes. Materials and Methods This is a retrospective population-based study of 201 women diagnosed with Gestational Diabetes Mellitus (GDM) between January 2012 and June 2014 in the area of Oviedo, Asturias, Spain. According to diagnostic criteria recommended by GEDE, NDDG, gestational diabetes is diagnosed if two or more plasma glucose levels meet or exceed the following threshold: fasting glucose of 105 mg/dl, 1-h 190 mg/dl, 2-h 165 mg/dl, or 3-h 145 mg/dl. We aim to know if there is any relationship between higher cutoffs and insulin requirement. Results 36 out of 201 patients (17.91%) needed insulin to achieve the targets of blood glucose control. There were no differences in mean maternal age and birthweights. Fasting blood glucose levels were significantly higher in women with further need for insulin than those who only needed diet and exercise (p < 0.001). Also, blood glucose levels 2 h after the oral glucose intake were statistically different between the two groups (p 0.032). AUC for fasting glucose value was the highest according to ROC curve. Conclusions Fasting cutoff vales for 100 g oral glucose tolerance test are consistently higher in women diagnosed with Gestational Diabetes that further needed insulin to achieve adequate blood glucose control. The positive predictive value of fasting glucose value 105 mg/dl on OGTT was 81.1%, whereas for the cut-off 95 mg/dl it was 54.0%.
Similar content being viewed by others
References
Akinci, B., Celtik, A., Yener, S., & Yesil, S. (2008). Is fasting glucose level during oral glucose tolerance test an indicator of the insulin need in gestation diabetes? Diabetes Research and Clinical Practice, 82, 219–225.
American Diabetes Association (ADA). (2015). Standards of medical care in diabetes 2015. DiabetesCare, 38(Suppl 1), S1–S90.
Buchanan, T. A., Kjos, S. L., Schafer, R. K., Peters, R. K., Xiang, A., Byrne, J., et al. (1998). Utility of fetal measuraments in the manegement of gestational diabetes mellitus. Diabetes Care, 21(Suppl 2), B99–B106.
Cabero, L., González, N., Cerqueira, M. J., Domenech, E., Jañez, M., Mozas, J., et al. Diabetes y embarazo. En: Sociedad Española de Ginecología y Obstetricia. Documentos de Consenso S.E.G.O. Madrid: 2003: 125-162.
Ferrara, A. (2007). Increasing prevalence of gestational diabetes mellitus: a public health perspective, Diabetes Care 30(Suppl. 2), S141–S146.
Grupo Español de Diabetes y Embarazo (GEDE). (2006). Sociedad Española de Diabetes (SED), Sociedad Española de Ginecología y Obstetricia (SEGO) y Asociación Española de Pediatría (Sección de Neonatología). Guía asistencial de diabetes mellitus y embarazo (3ª edición). Av Diabetol, 22, 73–87.
Gonzalez-Quintero, V. H., Istwan, N. B., Rhea, D. J., Tudela, C. M., Flick, A. A., de la Torre, L. et al. (2008). Antenatal factors predicting subsequent need for insulin treatment in women with gestational diabetes, Journal of Womens Health, 17 (7), 1183–1187.
Guideline Development Group (2008). Management of diabetes from preconception to the postnatal period: summary of NICE guidance. BMJ (Clinical research ed.), 336(7646), 714–717.
Hunt, K. J., & Schuller, K. L. (2007). The increasing prevalence of diabetes in pregnancy. Obstetrics & Gynecology Clinics of North America, 34(2), 173–199.
International Diabetes Federation. (2009). IDF clinical guidelines task force. Global guideline on pregnancy and diabetes. Brussels: International Diabetes Federation.
Jovanovic, L., & Peterson, C. M. (1985). Screening for gestational diabetes. Optimum timing criteria for retesting. Diabetes, 34(Suppl 2), 21.
Kjos, L., Schaefer-Grat, U., & Sardest, S. (2001). A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameterns to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Diabetes Care, 24, 1904–1910.
McFarland, M. B., Langer, O., Conway, D. L., & Berkus, M. D. (1999). Dietary therapy for gestational diabetes: how long is long enough? Obstetrics and Gynecology, 93(6), 978–982.
Metzger, B. E., Buchanan, T. A., Coustan, D. R., de Leiva, A., Dunger, D. B., Hadden, D. R., et al. (2007). Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes care, 30(Suppl 2), S251–S260.
National Diadetes Group (1979). Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes, 28(12), 1039–1057.
Prutsky, G. J., Domecq, J. P., Wang, Z., Carranza Leon, B. G., Elraiyah, T., Nabhan, M., et al. (2013). Glucose targets in pregnant women with diabetes: a systematic review and meta-analysis. The Journal of Clinical Endocrinology and Metabolism, 98(11), 4319–4324.
Sapienza, A. D., Francisco, R. P. V., Trindade, T. C., Zugaib, M. (2010). Factors predicting the need for insulin therapy in patients with gestational diabetes mellitus. Diabetes Research and Clinical Practice, 88, 81–86.
Scott, D. A., Loveman, E., McIntyre, L., & Waugh, N. (2002). Screening for gestational diabetes: a systematic review and economic evaluation. Health Technology Assessment, 6(11), 1–161.
Tan, Y. Y., Liauw, P. C., & Yeo, G. S. (1995). Using glucose tolerance test results to predict insulin requirement in women with gestational diabetes. Australian and New Zealand Journal of Obstetrics and Gynaecology, 35(3), 262–266.
World Health Organization (WHO).(2008). Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva: World Health Organization
Acknowledgements
We are particularly grateful to the Endocrine Department of Hospital Universitario Central de Asturias for their help with data collection.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Ares, J., Martín-Nieto, A., Díaz-Naya, L. et al. Gestational Diabetes Mellitus (GDM): Relationship Between Higher Cutoff Values for 100 g Oral Glucose Tolerance Test (OGTT) and Insulin Requirement During Pregnancy. Matern Child Health J 21, 1488–1492 (2017). https://doi.org/10.1007/s10995-017-2269-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-017-2269-0