Multiple positive points during the 75 g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeks
ABSTRACT Aims/Introduction This study evaluated the risk factors for insulin therapy before 24 gestational weeks (early insulin therapy) in pregnant women with gestational diabetes diagnosed before 24 gestational weeks (E‐GDM). Materials and Methods This study included 530 singleton mothers with E‐G...
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| Format: | Article |
| Language: | English |
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Wiley
2024-12-01
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| Series: | Journal of Diabetes Investigation |
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| Online Access: | https://doi.org/10.1111/jdi.14318 |
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| author | Yoshifumi Kasuga Marina Takahashi Kaoru Kajikawa Keisuke Akita Junko Tamai Yuka Fukuma Yuya Tanaka Keita Hasegawa Toshimitsu Otani Satoru Ikenoue Mamoru Tanaka |
| author_facet | Yoshifumi Kasuga Marina Takahashi Kaoru Kajikawa Keisuke Akita Junko Tamai Yuka Fukuma Yuya Tanaka Keita Hasegawa Toshimitsu Otani Satoru Ikenoue Mamoru Tanaka |
| author_sort | Yoshifumi Kasuga |
| collection | DOAJ |
| description | ABSTRACT Aims/Introduction This study evaluated the risk factors for insulin therapy before 24 gestational weeks (early insulin therapy) in pregnant women with gestational diabetes diagnosed before 24 gestational weeks (E‐GDM). Materials and Methods This study included 530 singleton mothers with E‐GDM who underwent a 75 g oral glucose tolerance test (OGTT) in the first trimester at Keio University Hospital between January 2013 and December 2021. E‐GDM can be classified according to its management into only diet therapy until delivery (Diet E‐GDM), insulin therapy started before 24 gestational weeks (EarlyIns E‐GDM), and insulin therapy started after 24 gestational weeks (LateIns E‐GDM). We analyzed the risk factors for EarlyIns E‐GDM. Results Patients with EarlyIns E‐GDM had a significantly higher maternal age at delivery, pre‐pregnancy BMI, first trimester hemoglobin A1c, 1 h plasma glucose levels (1 h‐PG), and 2 h‐PG, as well as a more pronounced initial increase and subsequent decrease, compared with those in the Diet E‐GDM group. However, the Apgar scores at both 1 and 5 min were significantly lower in patients with EarlyIns E‐GDM than in those with Diet E‐GDM. The number of abnormal values in the OGTT showed the largest area under the receiver operating characteristic curve (AUC) for predicting EarlyIns E‐GDM (0.83, 95% confidence interval [CI]: 0.79–0.86), followed by the 1 h‐PG value (AUC: 0.81, 95% CI: 0.77–0.85). The initial increase showed the third largest AUC (0.78, 95% CI: 0.74–0.82). Conclusions Although further research is needed, our data suggest the importance of early insulin therapy in cases of E‐GDM with multiple abnormal OGTT values, especially with high 1 h‐PG levels and initial increase. |
| format | Article |
| id | doaj-art-16205af2cb4d45fe8381bfa8aa1834a4 |
| institution | OA Journals |
| issn | 2040-1116 2040-1124 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Diabetes Investigation |
| spelling | doaj-art-16205af2cb4d45fe8381bfa8aa1834a42025-08-20T02:35:54ZengWileyJournal of Diabetes Investigation2040-11162040-11242024-12-0115121803180810.1111/jdi.14318Multiple positive points during the 75 g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeksYoshifumi Kasuga0Marina Takahashi1Kaoru Kajikawa2Keisuke Akita3Junko Tamai4Yuka Fukuma5Yuya Tanaka6Keita Hasegawa7Toshimitsu Otani8Satoru Ikenoue9Mamoru Tanaka10Department of Obstetrics and Gynecology Keio University School of Medicine Shinjuku‐ku Tokyo JapanDepartment of Obstetrics and Gynecology Keio University School of Medicine Shinjuku‐ku Tokyo JapanDepartment of Obstetrics and Gynecology Keio University School of Medicine Shinjuku‐ku Tokyo JapanDepartment of Obstetrics and Gynecology Keio University School of Medicine Shinjuku‐ku Tokyo JapanDepartment of Obstetrics and Gynecology Keio University School of Medicine Shinjuku‐ku Tokyo JapanDepartment of Obstetrics and Gynecology Keio University School of Medicine Shinjuku‐ku Tokyo JapanDepartment of Obstetrics and Gynecology Keio University School of Medicine Shinjuku‐ku Tokyo JapanDepartment of Obstetrics and Gynecology Keio University School of Medicine Shinjuku‐ku Tokyo JapanDepartment of Obstetrics and Gynecology Keio University School of Medicine Shinjuku‐ku Tokyo JapanDepartment of Obstetrics and Gynecology Keio University School of Medicine Shinjuku‐ku Tokyo JapanDepartment of Obstetrics and Gynecology Keio University School of Medicine Shinjuku‐ku Tokyo JapanABSTRACT Aims/Introduction This study evaluated the risk factors for insulin therapy before 24 gestational weeks (early insulin therapy) in pregnant women with gestational diabetes diagnosed before 24 gestational weeks (E‐GDM). Materials and Methods This study included 530 singleton mothers with E‐GDM who underwent a 75 g oral glucose tolerance test (OGTT) in the first trimester at Keio University Hospital between January 2013 and December 2021. E‐GDM can be classified according to its management into only diet therapy until delivery (Diet E‐GDM), insulin therapy started before 24 gestational weeks (EarlyIns E‐GDM), and insulin therapy started after 24 gestational weeks (LateIns E‐GDM). We analyzed the risk factors for EarlyIns E‐GDM. Results Patients with EarlyIns E‐GDM had a significantly higher maternal age at delivery, pre‐pregnancy BMI, first trimester hemoglobin A1c, 1 h plasma glucose levels (1 h‐PG), and 2 h‐PG, as well as a more pronounced initial increase and subsequent decrease, compared with those in the Diet E‐GDM group. However, the Apgar scores at both 1 and 5 min were significantly lower in patients with EarlyIns E‐GDM than in those with Diet E‐GDM. The number of abnormal values in the OGTT showed the largest area under the receiver operating characteristic curve (AUC) for predicting EarlyIns E‐GDM (0.83, 95% confidence interval [CI]: 0.79–0.86), followed by the 1 h‐PG value (AUC: 0.81, 95% CI: 0.77–0.85). The initial increase showed the third largest AUC (0.78, 95% CI: 0.74–0.82). Conclusions Although further research is needed, our data suggest the importance of early insulin therapy in cases of E‐GDM with multiple abnormal OGTT values, especially with high 1 h‐PG levels and initial increase.https://doi.org/10.1111/jdi.14318Gestational diabetes mellitusInsulinOral glucose tolerance test |
| spellingShingle | Yoshifumi Kasuga Marina Takahashi Kaoru Kajikawa Keisuke Akita Junko Tamai Yuka Fukuma Yuya Tanaka Keita Hasegawa Toshimitsu Otani Satoru Ikenoue Mamoru Tanaka Multiple positive points during the 75 g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeks Journal of Diabetes Investigation Gestational diabetes mellitus Insulin Oral glucose tolerance test |
| title | Multiple positive points during the 75 g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeks |
| title_full | Multiple positive points during the 75 g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeks |
| title_fullStr | Multiple positive points during the 75 g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeks |
| title_full_unstemmed | Multiple positive points during the 75 g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeks |
| title_short | Multiple positive points during the 75 g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeks |
| title_sort | multiple positive points during the 75 g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeks |
| topic | Gestational diabetes mellitus Insulin Oral glucose tolerance test |
| url | https://doi.org/10.1111/jdi.14318 |
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