Abstract
Since glycemic control is usually achieved through a trial-and-error methods, we aimed to evaluate the glycemic control prediction ability of fasting glucose and insulin levels at different time points. We performed a prospective study of women diagnosed with GDM, with singleton gestations, in a tertiary medical center. Laboratory workup which included fasting blood samples for blood count, chemistry, glucose and insulin. We calculated insulin resistance and sensitivity using the HOMA-IR and QUICKI models, respectively. Each patient was given nutritional consult and was instructed to measure glucose levels 6 times daily. Level of glycemic control was evaluated one week later, and women with more than 20% of measurements exceeding 95mg/dL at fasting or 120mg/dL 2-hours postprandial, or mean capillary glucose≥105mg/dL (poor glycemic control), were given medical treatment (insulin or Glyburide). We compared women with poor glycemic control with women with good glycemic control. We recruited 75 women, of which 26 (34.7%) were poorly controlled. Poorly controlled women had higher mean maternal age, and higher first trimester, OGTT and first visit fasting glucose levels, as well as higher first visit fasting insulin level. They also had higher HOMA-IR and lower QUICKI. Using a multivariate logistics regression model, HOMA-IR, QUICKI, first trimester fasting glucose, and first visit fasting insulin and glucose were found to be independently associated with poor glycemic control. We also calculated a ROC curve, which demonstrated that for a fixed specificity of 91%, first visit fasting glucose of 94.5mg/dL achieved the greatest sensitivity, PPV and NPV. Fasting glucose in the first trimester, OGTT and first visit, as well as first visit fasting insulin are all significantly higher among women with poorly controlled GDM. First visit fasting glucose have the best test performance measures to predict poor glycemic control.View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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