Predictive risk factors of insulin use requirement in patients with gestational diabetes

Abstract

Introduction: Gestational diabetes (GDM) is impaired glucose tolerance that begins or is first recognized during ongoing pregnancy.

Poor glycemic control increases the risk of severe maternal-fetal complications, which is why strict management of GDM is essential to prevent them.

The choice of treatment with a nutritional plan or insulin depends fundamentally on the glycemic objectives achieved, and recognizing the risk factors that predict its failure allows this management to be optimized.

Objectives: determine the risk factors that predict the need for insulin use in GDM.

Materials and methods: analytical, observational, retrospective and cross-sectional study in 107 patients with a diagnosis of GDM, during the months of March to December 2016. The study of the data was carried out by analysis of X2 tests and the results presented in percentages and odds ratio values.

Results: 107 cases of women diagnosed with GDM were analyzed, of which 56 (52.34%) received only treatment with a nutritional plan, while the remaining 51 (47.66%) started insulin therapy. The most relevant risk factors associated with the need to use insulin were fasting blood glucose levels greater than 85 mg/dl in the first trimester (OR 3.93), pregestational overweight or obesity (OR 3.2), diagnosis of GDM before week 20 (OR 3.2), personal history of DMG (OR 2.5) or
macrosomia (OR 2.1), maternal age over
30 years old (OR 1.8), multiparity (OR 1.7) and history of first-degree relatives with
DM (OR 1.2).

Conclusions: GDM is an important metabolic disorder that results in poor maternal and fetal outcomes. Insulin is the only drug approved for its management, so it is important to determine the predictors of the prenatal need for its use. In our study we show that the
high blood glucose in the first trimester,
pregestational overweight or obesity and
The diagnosis of GDM before 20 weeks implies a risk three times greater than the control group. Recognizing these predictive factors warns of eventual failure of glycemic goals after the nutritional plan and requires stricter monitoring and early initiation of insulin therapy.