Endocrine Abstracts

Introduction

Insulin therapy in gestational diabetes (GD) is the second line of therapy after failure of diet rules (DR). The aim of our study was to determine the predictive factors for switching to insulin in gestational diabetes.

Method

This is a descriptive cross-sectional retrospective study, including 82 patient files followed at the gestational diabetes unit of the National nutrition institute.

We analysed

Age, term of pregnancy at first consult, initial blood sugar level, family history of diabetes cases, pre-conceptional Body Mass Index (BMI), weight gain during pregnancy and obstetric history.

Results

The average age of our population was 33.5 years (19–44 years). The average pre-conceptional BMI was 29 kg/m² (18–47.2 kg/m²).The average GD discovery term was 28 weeks. A family history of diabetes cases was found in 46.3% of the cases. The average gestity was 3 and the average parity was 2. The history of GD was found in 13.4% of cases, a fetal death was found in 11% of cases and fetal macrosomia in 12.2% of cases. The diet rule lead to achieve glycemic targets in 77.5% of patients and a switch to insulin therapy was imperative in 22.5% of cases. The average of HBa1c was 5.2%. No significant relationship was found between age, preconceptionl BMI, weight gain during pregnancy, and use of insulin therapy during GD. The use of insulin was more frequent when there is a history of foetal macrosomia (P = 0.022), when the term of discovery of GD is early (less than 24 weeks) (P = 0.045), when initial blood sugar level > 1 g/l (P = 0.045) and increased pregnancy (P = 0.042).

Conclusion

In our study, history of macrosomia, early discovery term of GD, baseline blood glucose > 1 g/l and numerous pregnancies are predictors of insulin use during GD. In the presence of these factors, an intensification of DR and closer monitoring should be implemented for better management.