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Different Gestational Diabetes Phenotypes: Which Insulin Regimen Fits Better?
- Source :
- Frontiers in Endocrinology, Vol 12 (2021), Frontiers in Endocrinology
- Publication Year :
- 2021
- Publisher :
- Frontiers Media SA, 2021.
-
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 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.
- Subjects :
- Blood Glucose
obesity
endocrine system diseases
medicine.medical_treatment
insulin analogues
Endocrinology, Diabetes and Metabolism
Reproductive technology
lcsh:Diseases of the endocrine glands. Clinical endocrinology
Body Mass Index
gestational diabetes mellitus (GDM)
0302 clinical medicine
Endocrinology
Pregnancy
Insulin
body mass index (BMI)
Medical nutrition therapy
Family history
Original Research
030219 obstetrics & reproductive medicine
Pregnancy Outcome
oral glucose tolerance test (OGTT)
Fasting
Metformin
Gestational diabetes
Phenotype
Italy
Female
Nutrition Therapy
Adult
medicine.medical_specialty
Mothers
030209 endocrinology & metabolism
03 medical and health sciences
Diabetes mellitus
Internal medicine
medicine
Humans
Glycemic
Retrospective Studies
lcsh:RC648-665
business.industry
nutritional and metabolic diseases
Glucose Tolerance Test
medicine.disease
Obesity
Diabetes, Gestational
Multivariate Analysis
glycemic control
hyperglycemia
business
diet
Subjects
Details
- Language :
- English
- ISSN :
- 16642392
- Volume :
- 12
- Database :
- OpenAIRE
- Journal :
- Frontiers in Endocrinology
- Accession number :
- edsair.doi.dedup.....3d56f30022beb94d3e6d71812a6041bd
- Full Text :
- https://doi.org/10.3389/fendo.2021.630903