Clinical characteristics of ketosis in patients with gestational diabetes mellitus

Abstract

Objective To explore the clinical characteristics of ketosis in patients with gestational diabetes mellitus (GDM). Methods It was an observational retrospective study. Based on the testing result of urine ketone body and blood β-hydroxybutyric acid, 77 cases with gestational diabetes mellitus from January 2015 to April 2016 treated in the Clinical Nutrition Department of Beijing Anzhen Hospital were allocated into two groups: GDM with diabetic ketosis as the observation group (n=37) and GDM without diabetic ketosis as the control group (n=40). Family history, past medical history and treatment record, blood pressure, glycosylated hemoglobin, total protein (TP), serum albumin (ALB), urea, creatinine, hemoglobin and other indexes were collected. Blood glucose was recorded by the continuous glucose monitoring system. The data of two groups was statistically compared by using χ2 test and t test. Results The daily average blood glucose, fasting blood glucose, 2-hour after dinner blood glucose, hyperglycemia events, hyperglycemic duration and minimal blood glucose in the observation group were all significantly lower than those in the control group (t=-4.156--0.745, all P<0.05). The level of TP in the observation group was lower than that of the control group [(58.4±3.7) vs (67.0±2.9) g/L, t=-0.796, P=0.034]. The incidence rate of hypoproteinemia and percentage of patients who had decreased ALB in the observation group were both significantly higher than those of the control group [100%(37/37) vs 25.0%(10/40), 100%(37/37) vs 80.0%(32/40), χ2=45.463, 8.258, both P<0.05]. Total calorie intake, carbohydrate intake and energy contribution in the observation group were all significantly lower than those in the control group [(1 846±229) vs (2 119±186) g, (230±45) vs (300±36)g, 50.2%±4.1% vs 57.5%±3.6%, t=-5.780,-7.568,-8.363, all P<0.05]. Conclusions Ketosis in GDM patients is mainly starvation ketosis. Compared with patients without ketosis, total calorie intake, especially carbohydrate intake in GDM with ketosis are more insufficient. On the premise of diet control in GDM patient, it is suggested to ensure total calorie intake, and high quality protein intake should be appropriately increased, so as to attain the qualified blood glucose meanwhile reducing the risk of ketosis. Key words: Gestational diabetes mellitus; Ketosis; Urine ketone body