Can maternal abdominal fat thickness predict antenatal insulin therapy in patients with gestational diabetes mellitus?

Objective.To identify factors predicting the need for insulin therapy in pregnancies complicated by gestational diabetes mellitus (GDM).Methods. A total of 1352 patients with GDM diagnosed by the 75-g/2-h oral glucose tolerance test (OGTT) were enrolled in this study. Univariate and multivariate analysis were performed; receiver operating characteristics (ROC) were also drawn.Results. There was a significant difference in factors such as maternal age, pregestational BMI, first visit SBP, first visit DBP, FBG of first visit, FBG at time of OGTT, 75-g OGTT glucose value (fasting, after 1 h and 2 h), and serum HbA1c level at diagnosis between patients with insulin therapy and patients with medical nutrition therapy (MNT) alone. Multivariate analysis showed that higher FBG at time of OGTT, first 75 g OGTT 2 h plasma glucose, and HbA1c concentration at diagnosis lead to more likely need of insulin therapy.Conclusion. The probability of insulin therapy can be estimated in pregnant women with GDM based on fasting and 2 h glucose values during OGTT and HbA1c value at diagnosis of GDM.

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Clinical Impact of the TCF7L2 Gene rs7903146 Type 2 Diabetes Mellitus Risk Polymorphism in Women with Gestational Diabetes Mellitus: Impaired Glycemic Control and Increased Need of Insulin Therapy

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1008-9223 ◽

2019 ◽

Vol 128 (10) ◽

pp. 663-666

Author(s):

Laura Potasso ◽

Nikolaos Perakakis ◽

Apostolia Lamprinou ◽

Elektra Polyzou ◽

Dimitrios Kassanos ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Insulin Therapy ◽

Glucose Tolerance Test ◽

Risk Allele ◽

Tolerance Test ◽

Oral Glucose ◽

Tcf7l2 Rs7903146

Abstract Background The single nucleotide polymorphism in TCF7L2 rs7903146 is associated with an increased risk of type 2 diabetes mellitus and gestational diabetes mellitus. Mechanisms by which this mutation acts, and its impact on the clinical course of the diseases remain unclear. Here we investigated the clinical impact of the T risk allele in women with gestational diabetes mellitus. Methods We genotyped the C/T polymorphism in 164 Caucasian women with GDM (German n=114; Greek n=50). The impact of the T allele on the results of the 75g oral-glucose-tolerance-test, and on the required therapy (diet/lifestyle or insulin) was investigated. Results During oral-glucose-tolerance-test, women harboring the T allele displayed significantly higher glucose values at 60 min (p=0.034) and were more likely to require insulin therapy even after adjusting for confounders, such as BMI and age. Conclusion These results provide evidence that the T risk allele in TCF7L2 rs7903146 is associated with failure in early postprandial glycemic control and requirement of insulin therapy in women with gestational diabetes mellitus, even after adjusting for confounding factors such BMI and age.

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Treatment of gestational diabetes mellitus: Oral hypoglycemic agents compared to subcutaneous insulin therapy

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2006.10.093 ◽

2006 ◽

Vol 195 (6) ◽

pp. S36 ◽

Cited By ~ 1

Author(s):

Yvonne Cheng ◽

Judith Chung ◽

Ingrid Block-Kurbisch ◽

Maribeth Inturrisi ◽

Aaron Caughey

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Insulin Therapy ◽

Hypoglycemic Agents ◽

Subcutaneous Insulin ◽

Oral Hypoglycemic Agents

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A novel validated model for the prediction of insulin therapy initiation and adverse perinatal outcomes in women with gestational diabetes mellitus

Diabetologia ◽

10.1007/s00125-016-4047-8 ◽

2016 ◽

Vol 59 (11) ◽

pp. 2331-2338 ◽

Cited By ~ 26

Author(s):

Robyn A. Barnes ◽

Tang Wong ◽

Glynis P. Ross ◽

Bin B. Jalaludin ◽

Vincent W. Wong ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Insulin Therapy ◽

Perinatal Outcomes ◽

Therapy Initiation ◽

Adverse Perinatal Outcomes

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Risk Factors for the Requirement of Antenatal Insulin Treatment in Gestational Diabetes Mellitus

Journal of Diabetes Research ◽

10.1155/2016/9648798 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Mayu Watanabe ◽

Akihiro Katayama ◽

Hidetoshi Kagawa ◽

Daisuke Ogawa ◽

Jun Wada

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Insulin Therapy ◽

Pregnant Women ◽

Plasma Glucose ◽

Insulin Treatment ◽

Diet Group ◽

Glucose Levels

Poor maternal glycemic control increases maternal and fetal risk for adverse outcomes, and strict management of gestational diabetes mellitus (GDM) is recommended to prevent neonatal and maternal complications. However, risk factors for the requirement of antenatal insulin treatment (AIT) are not well-investigated in the pregnant women with GDM. We enrolled 37 pregnant women with GDM and investigated the risk for AIT by comparing the patients with AIT (AIT group;n=10) and without insulin therapy (Diet group;n=27). The 1-h and 2-h plasma glucose levels and the number of abnormal values in 75 g OGTT were significantly higher in AIT group compared with Diet group. By logistic regression analysis, plasma glucose level at 1-h was significant predictor for AIT and the odds ratios were 1.115 (1.004–1.239) using forward selection method and 1.192 (1.006–1.413) using backward elimination method. There were no significant differences in obstetrical outcomes and neonatal complications. 1-h plasma glucose levels in 75 g OGTT are useful parameters in predicting the requirement for AIT in GDM. Both maternal and neonatal complications are comparable in GDM patients with and without insulin therapy.

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Ultrasonographic visceral fat thickness in the first trimester can predict metabolic syndrome and gestational diabetes mellitus

Endocrine ◽

10.1007/s12020-013-0154-1 ◽

2014 ◽

Vol 47 (2) ◽

pp. 478-484 ◽

Cited By ~ 27

Author(s):

Esra Bahar Gur ◽

Ozlem Ince ◽

Guluzar Arzu Turan ◽

Muammer Karadeniz ◽

Sumeyra Tatar ◽

...

Keyword(s):

Diabetes Mellitus ◽

Metabolic Syndrome ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Visceral Fat ◽

First Trimester ◽

Fat Thickness

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Maternal abdominal subcutaneous fat thickness as a simple predictor for gestational diabetes mellitus

Journal of Perinatal Medicine ◽

10.1515/jpm-2018-0431 ◽

2019 ◽

Vol 47 (6) ◽

pp. 605-610 ◽

Cited By ~ 6

Author(s):

Mehmet Sukru Budak ◽

Ilker Kahramanoglu ◽

Salvatore Giovanni Vitale ◽

Sedat Akgol ◽

Mehmet Emin Dilek ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Screening Program ◽

Subcutaneous Fat ◽

Obstetric Ultrasound ◽

Roc Curve Analysis ◽

Predictive Values ◽

Subcutaneous Fat Thickness ◽

Fat Thickness

Abstract Background To date, only a limited number of studies have evaluated the importance of abdominal subcutaneous fat thickness (ASFT) on gestational diabetes mellitus (GDM) screening. The aim of this study was to investigate the effectiveness of ASFT measurement during routine obstetric ultrasound performed between 24 and 28 weeks of gestation in predicting cases with GDM. Methods This prospective comparative study was conducted on 50 cases with GDM and 50 cases without GDM in the GDM screening program at 24–28 gestational weeks between January 2018 and May 2018. The most accurate ASFT cut-off point values were determined for the prediction of cases with GDM by performing receiver operator characteristic (ROC) curve analysis. Results The ASFT was higher in those with GDM compared to those without GDM (P < 0.05). For an ASFT cut-off point value of 18.1 mm for the prediction of cases with GDM, the sensitivity, specificity, negative and positive predictive values were 72.0%, 60.0%, 64.2% and 68.1%, respectively. The risk of GDM increased 3.86-fold in those with ASFT level >18.1 mm (P = 0.001). Conclusion The ASFT value measured by routine obstetric ultrasound performed at 24–28 weeks of gestation was found to be significantly higher in patients with GDM in comparison to those without GDM. However, further multi-centered and comprehensive prospective studies are required to better demonstrate this relationship.

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