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We sought to develop a prediction model to identify women with gestational diabetes (GDM) who require insulin to achieve glycemic control.Retrospective cohort of all singletons with GDM treated with glyburide from 2007 to 2013. Glyburide failure was defined as reaching glyburide 20 mg day(-1) and receiving insulin. Glyburide success was defined as any glyburide dose without insulin and70% of visits with glycemic control. Multivariable logistic regression analysis was performed to create a prediction model.Of the 360 women, 63 (17.5%) qualified as glyburide failure and 157 (43.6%) as glyburide success. The final prediction model for glyburide failure included prior GDM, GDM diagnosis ⩽26 weeks, 1-h glucose challenge test ⩾228 mg dl(-1), 3-h glucose tolerance test 1-h value ⩾221 mg dl(-1), ⩾7 postprandial blood sugars120 mg dl(-1) in the week glyburide started and ⩾1 blood sugar200 mg dl(-1). The model accurately classified 81% of subjects.Women with GDM who will require insulin can be identified at the initiation of pharmacological therapy.

This study investigated the prevalence of gestational dysglycemia in a largely Hispanic population in a U.S.-Mexico border city and the influence of single plasma glucose (PG) result on the identification of gestational carbohydrate intolerance. Gestational dysglycemia was studied in a largely Mexican-American population using retrospective data. Gestational diabetes (GDM), gestational impaired fasting glucose (GIFG), and gestational impaired glucose tolerance (GIGT) were identified with Carpenter-Coustan thresholds. Glucose challenge test result was abnormal in 32.7% of 18307 women screened; 47% of them had one or more dysglycemic results in the confirmatory oral glucose tolerance test (OGTT). The prevalence of GDM, GIFG, and GIGT in these women was 8.7, 2.2, and 4.5%, respectively. Fasting, 1-hour, 2-hour, and 3-hour PGs were elevated in 20.5, 28.5, 25.0, and 15.0% of OGTT, respectively (GIFG: 6.0%; 1-hour GIGT: 6.5%; 2-hour GIGT: 4.4%; and 3-hour GIGT: 3.1%). Twelve percent of OGTTs showed dysglycemia at 1 hour with normal 2-hour PG. Isolated dysglycemia, similar to GDM, is prevalent in Mexican-American women. The minimal impact of 3-hour PG supports a 2-hour OGTT. But our results question the use of an "OGTT protocol without a first-hour specimen."

OBJECTIVE To estimate the prevalence of postpartum glucose testing within 6 months of pregnancies complicated by gestational diabetes mellitus (GDM), assess factors associated with testing and timing of testing after delivery, and report the test results among tested women. RESEARCH DESIGN AND METHODS This was a retrospective study of 11,825 women who were identified as having GDM using the 100-g oral glucose tolerance test (OGTT) from 1999 to 2006. Postpartum testing (75-g 2-h OGTT or fasting plasma glucose [FPG]) within 6 months of delivery and test results from laboratory databases are reported. Postpartum test results are categorized as normal, impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT), and provisionally diabetic. RESULTS About half (n = 5,939) the women were tested with either a FPG or 75-g OGTT from 7 days to 6 months postpartum. Of these women, 46% were tested during the 6- to 12-week postpartum period. Odds of testing were independently associated with age, race/ethnicity, household income, education, foreign-born status, parity, mode of delivery, having a postpartum visit, having GDM coded at discharge, and pharmacotherapy for GDM. Of the 5,857 women with test results, 16.3% (n = 956) had IFG/IGT and 1.1% (n = 66) had provisional diabetes. After adjustment for demographic and clinical factors, abnormal postpartum test results was associated with having required insulin, glyburide, or metformin during pregnancy and with longer period from delivery to postpartum testing. CONCLUSIONS After a pregnancy complicated by GDM, automated orders for postpartum testing with notification to physicians and electronically generated telephone and e-mail reminder messages to patients may improve the rates of postpartum testing for persistence of glucose intolerance.

OBJECTIVE Progressive β-cell loss causes catabolism in cystic fibrosis. Existing diagnostic criteria for diabetes were based on microvascular complications rather than on cystic fibrosis–specific outcomes. We aimed to relate glycemic status in cystic fibrosis to weight and lung function changes. RESEARCH DESIGN AND METHODS We determined peak blood glucose (BGmax) during oral glucose tolerance tests (OGTTs) with samples every 30 min for 33 consecutive children (aged 10.2–18 years). Twenty-five also agreed to undergo continuous glucose monitoring (CGM) (Medtronic). Outcome measures were change in weight standard deviation score (wtSDS), percent forced expiratory volume in 1 s (%FEV1), and percent forced vital capacity (%FVC) in the year preceding the OGTT. RESULTS Declining wtSDS and %FVC were associated with higher BGmax (both P = 0.02) and with CGM time >7.8 mmol/l (P = 0.006 and P = 0.02, respectively) but not with BG120 min. A decline in %FEV1 was related to CGM time >7.8 mmol/l (P = 0.02). Using receiver operating characteristic (ROC) analysis to determine optimal glycemic cutoffs, CGM time above 7.8 mmol/l ≥4.5% detected declining wtSDS with 89% sensitivity and 86% specificity (area under the ROC curve 0.89, P = 0.003). BGmax ≥8.2 mmol/l gave 87% sensitivity and 70% specificity (0.76, P = 0.02). BG120 min did not detect declining wtSDS (0.59, P = 0.41). After exclusion of two patients with BG120 min ≥11.1 mmol/l, the decline in wtSDS was worse if BGmax was ≥8.2 mmol/l (−0.3 ± 0.4 vs. 0.0 ± 0.4 for BGmax CONCLUSIONS BGmax ≥8.2 mmol/l on an OGTT and CGM time above 7.8 mmol/l ≥4.5% are associated with declining wtSDS and lung function in the preceding 12 months.

Objective: Coffee has several metabolic effects that could reduce the risk of type 2 diabetes. Our objective was to examine the effects of coffee consumption on glucose tolerance, glucose and insulin levels. Research design and methods: A subsample of subjects aged 45 to 64 years in 1987 and in 1992 from the population-based FINRISK study (12 287 individuals) was invited to receive the standard oral glucose tolerance test at baseline. Plasma samples were taken after an overnight fast, and a two-hour oral glucose tolerance test was administered. Fasting and two-hour plasma glucose and insulin wer e measured in 2434 subjects with data on coffee use and potential confounders. Results: After adjustment for potential confounding factors (age, body mass index, systolic blood pressur e, occupational, commuting and leisure time physical activity, alcohol and tea drinking, smoking), coffee consumption was significantly and inversely associated with fasting glucose, two-hour plasma glucose, and fasting insulin in both men and women. Coffee consumption was significantly and inversely associated with impaired fasting glucose, impaired glucose regulation, and h yperinsulinemia among both men and women and with isolated impaired glucose tolerance among women. Conclusions: In this cross-sectional analysis, coffee showed positive effects on several gl ycemia markers.

EDITORIAL COMMENT: This paper shows that the blood glucose values recorded in the glucose tolerance test which resulted in the diagnosis of gestational diabetes do not reliably predict which women will require insulin when dietary measures fail. It is not surprising that, in this study, the 2-hour glucose value correlated best with the need for insulin therapy since gestational diabetes was diagnosed solely on the basis of a high 2-hour glucose value (≥ 7.8 mmol/L). The data from the 596 women with gestational diabetes shown in the tables and figures should especially interest readers who manage women with gestational diabetes. In many centres women with gestational diabetes are managed without admission to hospital. Attendance at a day centre after initial diagnosis is helpful to arrange instruction from a diabetes educator and dietitian, including instruction regarding home monitoring of blood glucose levels in those where this seems necessary. In the clinics which the editorial subcommittee attend, insulin is commenced in women with gestational diabetes when the 2-hour postprandial plasma glucose level exceeds 6.5 mmol/L on 2 or more occasions, in spite of dietary measures. In this clinic women with gestational diabetes seldom require hospitalization for stabilization of blood glucose levels. Figures 1–3 clearly show that although insulin therapy is more likely to be indicated when fasting, 1-hour or 2-hour plasma values are high, there are many women with high values at these points on the glucose tolerance test resulting in diagnosis of gestational diabetes, who did not require insulin. Patient compliance with dietary advice is the one explanation of this finding which the clinician is most likely to be able to influence. Summary: This study was done to test the clinical impression that the result of the oral glucose tolerance test could be used to predict which patients with gestational diabetes did not need insulin therapy. If this was true, a full blood sugar profile assessment could be avoided in many of these women. The second analysis was to test the clinical impression that the fasting glucose level was the best predictor of insulin requirement in women with gestational diabetes. The results of the study showed that none of the 3 readings of the oral glucose tolerance test could be used to predict reliably which patients did not need insulin therapy. Hence, blood sugar profile assessment of all patients with gestational diabetes is still necessary. The receiver-operator characteristic curves also showed that the 2-hour postload glucose level during the 75 g load glucose tolerance test was a better predictor of insulin requirement than the fasting glucose level.

To investigate the metabolic phenotype and pregnancy outcomes of gestational impaired glucose tolerance (IGT) defined by isolated hyperglycemia during an oral glucose tolerance test (OGTT).Retrospective cohort study.University referral hospital.A total of 4,789 women were screened for gestational diabetes mellitus (GDM) between 1996 and 2008 with a glucose challenge test (GCT), followed by a 2-hour 75-g OGTT if the GCT result was abnormal; in addition, measurement of plasma insulin concentration during the OGTT was implemented from 2004.The insulin sensitivity (IS(OGTT)) and beta-cell function (insulinogenic index/homeostasis model assessment for insulin resistance) were calculated for 283 women who underwent a diagnostic OGTT between 2004 and 2008. Perinatal complications were examined in 4,789 women who were screened for GDM between 1996 and 2008.Comparison of outcomes among women stratified by glucose tolerance status using the GCT and OGTT profiles.Insulin sensitivity and beta-cell function significantly decreased from normal OGTT to 2-hour IGT (single hyperglycemia at 2 hours) to 1-hour IGT (single hyperglycemia at 1 hour) to GDM, with significant differences between normal OGTT and 1-hour IGT or GDM. The occurrence of large-for-gestational age (LGA) neonates was significantly increased in women with GDM or 1-hour IGT (adjusted odds ratio: 2.15, 2.22; 95% confidence interval 1.23-3.75 and 1.04-4.35, respectively) compared to those with normal GCT or normal diagnostic OGTT results.Like GDM, isolated 1-hour hyperglycemia on the OGTT is associated with beta-cell dysfunction and an increased risk for LGA neonates.

Pregnant women commonly receive screening for gestational diabetes mellitus by use of a 50 g glucose challenge test, followed by a diagnostic oral glucose tolerance test for those whose glucose challenge test result is abnormal. Although women with gestational diabetes have an increased risk of cardiovascular disease, it is not known whether mild glucose intolerance during pregnancy is also associated with cardiovascular disease. Thus, we sought to determine whether pregnant women with an abnormal glucose challenge test result but without gestational diabetes have an increased risk of cardiovascular disease.We conducted a retrospective population-based cohort study that included all women in Ontario aged 20-49 years with live deliveries between April 1994 and March 1998. We excluded women with pregestational diabetes. The population was stratified into 3 cohorts: women with gestational diabetes (n = 13,888); women who received an antepartum oral glucose tolerance test (suggestive of an abnormal result of the glucose challenge test) but who did not have gestational diabetes (n = 71,831); and women who did not receive an oral glucose tolerance test (suggestive of a normal result of the glucose challenge test) (n = 349,977). The primary outcome was cardiovascular disease (admission to hospital for acute myocardial infarction, coronary bypass, coronary angioplasty, stroke or carotid endarterectomy).Compared with women who did not receive an oral glucose tolerance test, women with gestational diabetes and women who received an oral glucose tolerance test but did not have gestational diabetes had a higher risk of cardiovascular disease over 12.3 years of median follow-up (adjusted hazard ratio [HR] for women with gestational diabetes 1.66, 95% confidence interval [CI] 1.30-2.13, p0.001; adjusted HR for those with an oral glucose test but not gestational diabetes 1.19, 95% CI 1.02-1.39, p = 0.03).Mild glucose intolerance in pregnancy may be associated with an increased risk of cardiovascular disease.

A recent randomized trial showed glyburide to be as effective as insulin for treating gestational diabetes mellitus (GDM). The present study evaluated glyburide in 75 women with GDM, diagnosed using the American DiabetesAssociation criteria. All women received nutritional therapy and were given a glucose meter with which to monitor blood sugar before and 2 hours after each meal and at bedtime. If good control (mean glucose of 105 mg/dL or less; fasting/premeal values of 95 mg/dL or lower; 2-hour postprandial values of 115 mg/dL or below) was not achieved within 2 weeks, women were offered glyburide as long as they were at 11 to 33 weeks gestational age and had a fasting blood glucose of less than 140 mg/dL during a 3-hour glucose tolerance test (GTT). The starting dose was 2.5 mg daily, usually given in the morning. The dose was adjusted as needed but only at intervals of 3 days or longer. Insulin was administered if glyburide treatment failed to produce adequate glycemic control. Glyburide provided good glycemic control in 63 of the 75 women (84%), whereas 12 received insulin before delivery. Patient characteristics and diabetes risk factors were similar in the 2 groups, but women who responded had significantly lower glucose levels on the GTT. The 2 groups did not differ in body mass index before pregnancy or at the time GDM was diagnosed. Women who required insulin had lower gestational ages at the time glyburide therapy began, and their overall mean blood glucose was higher (114 vs. 108 mg/dL). Only 2 of the 12 insulin-treated women had received maximum doses of glyburide. Eight of them did not achieve adequate blood sugar control by the time of delivery. Approximately three fourths of responsive women took 1 2.5- or 5-mg dose of glyburide once a day. Fetal macrosomia (birth weight exceeding 4000 g) was similarly frequent in the 2 groups, as were mean birth weights. A larger proportion of infants born to women who did not respond to glyburide required intravenous glucose infusions while in the nursery because of hypoglycemia (25% vs. 13%). Glyburide is effective in a substantial majority of women with GDM for whom nutritional therapy alone fails to adequately lower the blood glucose.