The function of oral glucose tolerance test protocols in diagnosing and managing gestational diabetes: can insulin requirements be predicted?

Gizem Aktemur; Betül Tokgöz Çakır; Gülşan Karabay; Nazan Vanlı Tonyalı; Zeynep Şeyhanlı; Ahmet Arif Filiz; Mevlüt Bucak; Damla Gürkan; Ali Çağlar

Article Details

The function of oral glucose tolerance test protocols in diagnosing and managing gestational diabetes: can insulin requirements be predicted?

Authors:

Gizem Aktemur | Betül Tokgöz Çakır | Gülşan Karabay | Nazan Vanlı Tonyalı | Zeynep Şeyhanlı | Ahmet Arif Filiz | Mevlüt Bucak | Damla Gürkan | Ali Çağlar

Publisher:

MediHealth Academy Yayıncılık

Main Topics:

Kadın Hastalıkları ve Doğum

Journal:

Journal of Health Sciences and Medicine Vol.8 Issue 2, pp.325-332

Document Type:

Article

Publication Date:

3/2025

Document Language:

English

Document ID (Org No.):

2001343111

pISSN:

2636-8579

Keywords:

Abstract:

 Aims: This study aims to evaluate the effectiveness of diagnostic tests, clinical, and laboratory markers in predicting insulin requirements in pregnant women diagnosed with gestational diabetes mellitus GDM. Additionally, we assessed differences in maternal and neonatal outcomes between insulin-managed and diet-managed GDM patients. Methods: A retrospective analysis was conducted on 406 pregnant women diagnosed with GDM at Ankara Etlik City Hospital between October 2022 and December 2024. Patients were categorized based on the diagnostic method used: the one-step 75 g oral glucose tolerance test OGTT or the two-step 100 g OGTT following a 50 g OGTT. Clinical, laboratory, and demographic data were compared between insulin-treated and diet-controlled groups. The predictive capacity of fasting plasma glucose FPG, glucose levels at 1st, 2nd, and 3rd hours during OGTT, and HbA1c for insulin requirement were assessed using receiver operating characteristic ROC analysis. Results: In the 75 g OGTT group, fasting, 1st-hour, and 2nd-hour glucose levels were significantly higher in the insulin-requiring group p0.001. ROC analysis indicated that fasting glucose 92 mgdl and 2nd hour glucose 160 mgdl were predictive of insulin requirement. HbA1c 5.25 was also a significant predictor p0.009. However, in the 100 g OGTT group, only the 2nd hour glucose level 169 mgdl, p0.032 was predictive of insulin need, while HbA1c was not statistically significant. Birth outcomes showed that insulin-treated patients had an earlier gestational age at delivery p0.001, but neonatal outcomes were not significantly different between insulin-treated and diet-managed groups. Conclusion: The findings suggest that glucose levels and HbA1c in the 75 g OGTT group are more effective in predicting insulin requirements in GDM patients than the 100 g OGTT. The study underscores the importance of identifying predictive markers for early intervention, potentially guiding clinicians in selecting optimal diagnostic methods and improving patient outcomes.

 Aims: This study aims to evaluate the effectiveness of diagnostic tests, clinical, and laboratory markers in predicting insulin requirements in pregnant women diagnosed with gestational diabetes mellitus GDM. Additionally, we assessed differences in maternal and neonatal outcomes between insulin-managed and diet-managed GDM patients. Methods: A retrospective analysis was conducted on 406 pregnant women diagnosed with GDM at Ankara Etlik City Hospital between October 2022 and December 2024. Patients were categorized based on the diagnostic method used: the one-step 75 g oral glucose tolerance test OGTT or the two-step 100 g OGTT following a 50 g OGTT. Clinical, laboratory, and demographic data were compared between insulin-treated and diet-controlled groups. The predictive capacity of fasting plasma glucose FPG, glucose levels at 1st, 2nd, and 3rd hours during OGTT, and HbA1c for insulin requirement were assessed using receiver operating characteristic ROC analysis. Results: In the 75 g OGTT group, fasting, 1st-hour, and 2nd-hour glucose levels were significantly higher in the insulin-requiring group p0.001. ROC analysis indicated that fasting glucose 92 mgdl and 2nd hour glucose 160 mgdl were predictive of insulin requirement. HbA1c 5.25 was also a significant predictor p0.009. However, in the 100 g OGTT group, only the 2nd hour glucose level 169 mgdl, p0.032 was predictive of insulin need, while HbA1c was not statistically significant. Birth outcomes showed that insulin-treated patients had an earlier gestational age at delivery p0.001, but neonatal outcomes were not significantly different between insulin-treated and diet-managed groups. Conclusion: The findings suggest that glucose levels and HbA1c in the 75 g OGTT group are more effective in predicting insulin requirements in GDM patients than the 100 g OGTT. The study underscores the importance of identifying predictive markers for early intervention, potentially guiding clinicians in selecting optimal diagnostic methods and improving patient outcomes.

 Aims: This study aims to evaluate the effectiveness of diagnostic tests, clinical, and laboratory markers in predicting insulin requirements in pregnant women diagnosed with gestational diabetes mellitus GDM. Additionally, we assessed differences in maternal and neonatal outcomes between insulin-managed and diet-managed GDM patients. Methods: A retrospective analysis was conducted on 406 pregnant women diagnosed with GDM at Ankara Etlik City Hospital between October 2022 and December 2024. Patients were categorized based on the diagnostic method used: the one-step 75 g oral glucose tolerance test OGTT or the two-step 100 g OGTT following a 50 g OGTT. Clinical, laboratory, and demographic data were compared between insulin-treated and diet-controlled groups. The predictive capacity of fasting plasma glucose FPG, glucose levels at 1st, 2nd, and 3rd hours during OGTT, and HbA1c for insulin requirement were assessed using receiver operating characteristic ROC analysis. Results: In the 75 g OGTT group, fasting, 1st-hour, and 2nd-hour glucose levels were significantly higher in the insulin-requiring group p0.001. ROC analysis indicated that fasting glucose 92 mgdl and 2nd hour glucose 160 mgdl were predictive of insulin requirement. HbA1c 5.25 was also a significant predictor p0.009. However, in the 100 g OGTT group, only the 2nd hour glucose level 169 mgdl, p0.032 was predictive of insulin need, while HbA1c was not statistically significant. Birth outcomes showed that insulin-treated patients had an earlier gestational age at delivery p0.001, but neonatal outcomes were not significantly different between insulin-treated and diet-managed groups. Conclusion: The findings suggest that glucose levels and HbA1c in the 75 g OGTT group are more effective in predicting insulin requirements in GDM patients than the 100 g OGTT. The study underscores the importance of identifying predictive markers for early intervention, potentially guiding clinicians in selecting optimal diagnostic methods and improving patient outcomes.

 Amaç: Gestasyonel diyabetes mellitus GDM, maternal ve fetal sonuçları olumsuz etkileyebilen önemli bir gebelik komplikasyonudur. GDM tanısında kullanılan farklı oral glukoz tolerans testi OGTT protokollerinin, insülin ihtiyacını öngörmedeki etkinliğinin değerlendirilmesi önemlidir. Bu çalışmada, GDM tanısı alan gebelerde insülin gereksinimini belirlemede kullanılan tanı testleri, klinik ve laboratuvar parametrelerinin rolü incelenmiştir. Yöntemler: Çalışmaya 406 GDM tanılı gebe dahil edilerek retrospektif analiz gerçekleştirilmiştir. Hastalar, 75 gr OGTT ile tanı konulanlar ve 100 gr OGTT ile tanı konulanlar olarak iki gruba ayrılmıştır. Demografik, klinik ve laboratuvar veriler karşılaştırılarak insülin gereksinimi ile ilişkili parametreler belirlenmiştir. ROC analizi ile insülin ihtiyacını öngörmede en iyi eşik değerler hesaplanmıştır. Bulgular: 75 gr OGTT ile değerlendirilen hastalarda açlık ve postprandiyal glukoz seviyeleri ile HbA1c düzeyleri, insülin gereksinimini öngörmede anlamlı bulunmuştur p0.001. Özellikle 2. saat glukoz seviyesi 160 mgdL, insülin ihtiyacını belirlemede yüksek özgüllük ve duyarlılık göstermiştir. 100 gr OGTT ile değerlendirilen hastalarda insülin ihtiyacını öngörmede anlamlı bir fark bulunmamıştır. İnsülin kullanan gebelerde doğum haftasının daha erken olduğu ve erkek bebek doğurma olasılığının daha yüksek olduğu gözlemlenmiştir p0.05. Ancak neonatal yoğun bakım ünitesi NICU yatış oranları açısından iki grup arasında anlamlı bir fark saptanmamıştır. Sonuç: 75 gr OGTT ile elde edilen glukoz seviyeleri ve HbA1c düzeyleri, insülin ihtiyacını öngörmede önemli belirteçler olarak öne çıkmaktadır. Tek basamaklı test, klinik karar verme sürecini kolaylaştırabilir ve maliyet etkin bir yaklaşım sağlayabilir.

Article Details

The function of oral glucose tolerance test protocols in diagnosing and managing gestational diabetes: can insulin requirements be predicted?

Authors:

Gizem Aktemur | Betül Tokgöz Çakır | Gülşan Karabay | Nazan Vanlı Tonyalı | Zeynep Şeyhanlı | Ahmet Arif Filiz | Mevlüt Bucak | Damla Gürkan | Ali Çağlar

Publisher:

MediHealth Academy Yayıncılık

Main Topics:

Kadın Hastalıkları ve Doğum

Journal:

Journal of Health Sciences and Medicine Vol.8 Issue 2, pp.325-332

Document Type:

Article

Publication Date:

3/2025

Document Language:

English

Document ID (Org No.):

2001343111

pISSN:

2636-8579

Gestational diabetes mellitus

OGTT

insulin therapy

HbA1c

predictive markers

pregnancy outcomesGestasyonel diyabet

OGTT

insülin ihtiyacı

glukoz tolerans testi

perinatal sonuçlar.

Issues

Article Details

Authors: Gizem Aktemur | Betül Tokgöz Çakır | Gülşan Karabay | Nazan Vanlı Tonyalı | Zeynep Şeyhanlı | Ahmet Arif Filiz | Mevlüt Bucak | Damla Gürkan | Ali Çağlar

Publisher: MediHealth Academy Yayıncılık

Main Topics: Kadın Hastalıkları ve Doğum

Journal: Journal of Health Sciences and Medicine Vol.8 Issue 2, pp.325-332

Document Type: Article

Publication Date: 3/2025

Document Language: English

Document ID (Org No.): 2001343111

pISSN: 2636-8579

Issues

Authors:

Gizem Aktemur | Betül Tokgöz Çakır | Gülşan Karabay | Nazan Vanlı Tonyalı | Zeynep Şeyhanlı | Ahmet Arif Filiz | Mevlüt Bucak | Damla Gürkan | Ali Çağlar

Publisher:

MediHealth Academy Yayıncılık

Main Topics:

Kadın Hastalıkları ve Doğum

Journal:

Journal of Health Sciences and Medicine Vol.8 Issue 2, pp.325-332

Document Type:

Article

Publication Date:

3/2025

Document Language:

English

Document ID (Org No.):

2001343111

pISSN:

2636-8579