Abstract
AimsTo identify factors predicting a need for insulin therapy in gestational diabetes mellitus (GDM) by comparing plasma glucose (PG) levels in a 75-g oral glucose tolerance test (75-g OGTT) with those in a 500-kcal meal tolerance test (MTT) containing 75 g of carbohydrate.Subjects and methodsThe MTT was performed in 61 patients who diagnosed with GDM by a 75-g OGTT (age, 33.2 ± 4.5 years; prepregnancy body mass index, 22.6 ± 4.7 kg/m2; number of gestational weeks, 25.1 ± 6.4 weeks). PG and serum insulin levels were measured before the meal and up to 180 min after the meal. The insulin secretion capacity and resistance index were calculated.ResultsPG levels increased from 86.8 ± 8.8 mg/dL at fasting to 132.7 ± 20.1 mg/dL at 30 min, and 137.8 ± 27.7 mg/dL at 60 min after MTT in the 35 patients with needed insulin therapy; these levels were significantly higher than those in the 26 patients, who only needed diet therapy. The patients with needed insulin therapy had significantly higher fasting PG levels in the 75-g OGTT, PG levels at fasting and 30 min after the MTT, and homeostasis model assessment of insulin resistance (HOMA-IR), and a significantly lower disposition index (DI) and insulin index than patients treated by diet alone. Receiver operating characteristic curve analysis was performed for factors involved in insulin therapy, with the following cutoff values: fasting PG in the 75-g OGTT, 92 mg/dL; PG 30 min after MTT, 129 mg/dL; HOMA-IR, 1.51; DI, 3.9; HbA1c, 5.4%. Multivariate analysis revealed that the 30-min PG level after MTT and HOMA-IR predicted insulin therapy.ConclusionPG levels at 30 min after MTT may be useful for identifying patients with GDM, who need insulin therapy.
Highlights
We compared the results of the meal tolerance test (MTT) and 75-g oral glucose tolerance test (OGTT) between the patients with high-risk gestational diabetes mellitus (GDM) who require insulin therapy and the patients who was managed by diet alone, and we evaluated the efficacy of the MTT for predicting a need for insulin therapy
The results were compared with plasma glucose (PG) levels in the 75-g OGTT performed at the time of diagnosis
A need for insulin therapy was predicted by a fasting PG level of 92 mg/dL in the 75-g OGTT, a PG level of 129 mg/dL 30 min after the MTT, a homeostasis model assessment of insulin resistance (HOMA-IR) of 1.51, a disposition index (DI) of 3.9, and an HbA1c of 5.4%
Summary
This study included 61 patients with a diagnosis of GDM after a 75-g OGTT, who were admitted to our hospital for diet education and diabetic control between January 2018 and January 2019. The patients performed the 75-g OGTT because of a blood glucose level of 100 mg/dL or higher at any time in early pregnancy, a positive urine glucose, or a positive 50-g OGTT in midpregnancy, and they were diagnosed with GDM according to the new criteria [3]. We excluded patients who were started on insulin therapy before hospitalization or who had a diagnosis of diabetes before pregnancy and at the time of pregnancy. Patients with twins or who were taking ritodrine were excluded. Patients with food allergies and gastro-intestinal disease were excluded.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
