Comparative Study on Clinical Characteristics and Outcomes of Overt Diabetes Mellitus and Gestational Diabetes Mellitus in Late Pregnancy

Abstract

Background: With the rising prevalence in recent years, gestational diabetes mellitus has become one of the leading causes of maternal and child mortality and morbidity worldwide and has raised health concern. It is seriously detrimental to both the women and fetuses. However, there are limited evidences of two types of gestational diabetes mellitus on clinical characteristics and outcomes. Therefore, this study was aimed to explore the clinical characteristics and outcomes of patients with overt diabetes mellitus (ODM) and gestational diabetes mellitus (GDM) at the late pregnancy. Methods: From January 2015 to August 2016, totally 63 gestational diabetes mellitus from the Department of Clinical Nutrition in Beijing Anzhen Hospital were enrolled in the study. Patients were classified into two groups. 31 patients with gestational overt diabetes mellitus were grouped into ODM group and 32 patients with gestational diabetes mellitus were grouped into GDM group. Clinical characteristics and outcomes were compared between ODM and GDM. We collected records of the age, gestational week, family history, past history, pregnancy complications, insulin use, blood pressure, clinical nutrition indexes, blood pressure. Glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), total protein (TP), albumin (ALB), prealbumin (PALB), hemoglobin (HGB), urea nitrogen (BUN), serum creatinine (CREA), and dynamic blood glucose monitoring were measured. And we recorded the changes of blood glucose and the test data. We statistically analyzed the data of two groups. Results: In the ODM group, HbA1c, FBG, average blood glucose, two-hour postprandial blood glucose (2hPBG) after breakfast, 2hPBG after dinner, the number of hyperglycemic events and high blood glucose time ratio are significantly higher than those of GDM and two groups compared with statistical significance (P 0.05). The number of patients treated with insulin (10/31) in ODM is significantly more than that in GDM (1/32) (P 0.05). 45% (14/31) of ODM have a family history of diabetes patients. The ratio is significantly higher than 13% (4/32) of GDM (P 0.05). There was significant difference in urinary ketone positive rate between the two groups (P 0.05), but there was no significant difference in urinary microalbumin abnormal rate between them (P > 0.05). The number of preeclampsia in ODM (8/31) is significantly higher than that of GDM (P 0.05). The level of HGB in ODM is lower than that of GDM (P 0.05). There was no difference in the pregnancy outcomes between the two groups. Conclusion: Late pregnancy women with ODM have obvious family history, higher HbA1c, higher FBG, higher glucose levels of two-hours after breakfast and dinner, higher average blood glucose, longer hypoglycemia time, higher probability of hyperglycemic events and greater opportunity to use insulin in the treatment of symptomatic patients, higher risk of preeclampsia, lower HGB level than GDM, while GDM has higher positive rate of urine ketone than ODM.