Abstract
ObjectiveMaternal characteristics and OGTT values of pregnancies complicated by gestational diabetes mellitus (GDM) were evaluated according to treatment strategies. The goal was to identify different maternal phenotypes in order to predict the appropriate treatment strategy.MethodsWe conducted a retrospective study among 1,974 pregnant women followed up for GDM in a tertiary referral hospital for high-risk pregnancies (Careggi University Hospital, Florence, Italy) from 2013 to 2018. We compared nutritional therapy (NT) alone (n = 962) versus NT and insulin analogues (n = 1,012) group. Then, we focused on different insulin analogues groups: long acting (D), rapid acting (R), both D and R. We compared maternal characteristics of the three groups, detecting which factors may predict the use of rapid or long-acting insulin analogue alone versus combined therapy.ResultsAmong women included in the analysis, 51.3% of them needed insulin therapy for glycemic control: 61.8% D, 28.3% combined D and R, and 9.9% R alone. Age >35 years, pre-pregnancy BMI >30, family history of diabetes, previous GDM, altered fasting plasma glucose (FPG), hypothyroidism, and assisted reproductive technologies (ART) were identified as maternal variables significantly associated with the need of insulin therapy. Altered 1-h and 2-h glucose plasma glucose level at OGTT, age >35 years, and previous GDM were found as independent predicting factors for the use of combined therapy with rapid and long acting analogues for glycemic control. On the contrary, pre-pregnancy BMI <25 and normal fasting plasma glucose values at OGTT were found to be significantly associated to the use of rapid insulin analogue only.ConclusionA number of maternal and metabolic variables may be identified at the diagnosis of GDM, in order to identify different GDM phenotypes requiring a personalized treatment for glycemic control.
Highlights
Gestational diabetes mellitus (GDM) is considered a major global health problem because of its increasing prevalence and the wellknown association between hyperglycemia in pregnancy and fetomaternal morbidity [1, 2]
In the study group 962 (48.7%) women were treated with nutritional therapy (NT) alone, whereas 1,012 (51.3%) women received diet and insulin therapy
Comparing the diet and insulin groups, we observed that patients who needed insulin therapy had higher pre-pregnancy BMI (23.9 ± 4.91 vs 25.2 ± 5.49, p < 0.001) and were more likely to be obese (6.3 vs 12%, p < 0.001)
Summary
Gestational diabetes mellitus (GDM) is considered a major global health problem because of its increasing prevalence and the wellknown association between hyperglycemia in pregnancy and fetomaternal morbidity [1, 2]. Short-acting analogues (Lispro and Aspart) have faster onset and shorter duration of action determining a more overlapping peak to the one of the endogenous insulin, reducing the risk of post-meal hypoglycemia and improving glycemic control in women with GDM [4, 5]. The long-acting analogues (Glargine and Detemir) and their good pharmacokinetic characteristics allow to control basal glycemia providing a flat and protracted pharmacodynamic profile [4, 6]. Their use has increased in the last decade because of the rising attention to fasting glucose profile control rather than post meal glycemic values. Maternal 1-h postprandial glycemic peak is one of the best predictor of fetal macrosomia, but fasting glucose levels significantly influence perinatal and neonatal outcome [7, 8]
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