Background: The management of gestational diabetes mellitus (GDM) is based on nutrition therapy associated to insulin therapy in second intention if glycemic targets are not achieved. The aim of this study was to assess predictive factors of insulin requirement in a group of pregnant women with GDM.
Methods: We conducted a retrospective study at the Outpatient Department and functional explorations, in the National Institute of Nutrition of Tunis, between April and June 2021. Clinical and biological data were collected from medical observation records.
Results: The study included 110 pregnant women with GDM. Mean age of patients was 33.4 ± 5 years. Diagnosis of GDM was based on pathological 75 g oral glucose tolerance test (OGTT) in 60% of patients and pathological fasting blood glucose in 40%, with a mean term of discovery of 22.75±7.55 weeks of gestation. Nearly to one-third (33.6%) of the patients required initiation of insulin therapy. The mean term of insulin therapy instauration was 27.27±5.55 weeks of gestation with a mean time between diagnosis of GDM and insulin therapy of 4.76±3.94 weeks. Insulin therapy was initiated during the first week of follow-up in 16.6%. Insulin therapy was initiated with short-acting insulin, NPH insulin and basal bolus pattern in 54.1%, 13.5% and 32.4% of cases respectively. Univariate analysis showed a significant association between level of education (P = 0.031), sedentarity (P = 0.013) and the need for insulin therapy. Glycated hemoglobin (A1c) was higher in women with insulin therapy (P = 0.018). We did not find a statistically significant association between insulin use and history of GDM, early discovery of GDM, maternal age, and fasting blood glucose. Multivariate analysis showed that predictive factors for insulin therapy were A1c (OR=4.34) and personal history of miscarriages (OR=3.67). ConclusionPregnant women who develop gestational diabetes treated with insulin are at increased risk of developing type 2 diabetes in the future. Thats why postpartum management is essential based on long-term screening and diabetes prevention strategies.
21 May 2022 - 24 May 2022