Tight versus less tight 1-hour postprandial glycemic target in women with gestational diabetes mellitus — a single-center cohort study
, 23, 4, 3, 23, 23, 23
Abstract
Objectives: We aimed to assess the impact of the change of 1-hour postprandial glycemic target from < 6.7 mmol/L (120 mg/dL) to < 7.8 mmol/L (140 mg/dL) on gestational diabetes mellitus (GDM) treatment and pregnancy outcomes.
Material and methods: In a retrospective analysis of 1021 GDM patients from the Department of Metabolic Diseases, University Hospital in Cracow, Poland, we compared insulin therapy regimens and pregnancy outcomes between women admitted in 2014–2016 (before the change) and in 2018–2019 (after it).
Results: A total of 377 patients were admitted between 2014 and 2016 (TIGHT group) and 644 between 2018 and 2019 (LESS TIGHT group). Women from the LESS TIGHT group were older (32 vs 30 years, p < 0.001) and gained less weight during pregnancy (7.0 vs 9.0 kg, p < 0.001). There was no change in the frequency of any insulin therapy (51.6% vs 56.1%, p = 0.168). In the LESS TIGHT group, the basal insulin-only model was used more frequently (32.5% vs 10.2%, p < 0.001), while the prandial insulin and basal-bolus model less frequently (23.6% vs 42.6% and 21.4% vs 36.7%, p < 0.001, respectively) than in the TIGHT group. There were no differences in the frequency of cesarean sections, preterm births, Hbd of delivery, mean birth weight or prevalence of perinatal complications.
Conclusions: Less tight glycemic targets in women with GDM, compared to tighter targets, were associated with less frequent use of prandial insulin, with insulin therapy often limited to basal administration. The change in glycemic targets did not affect the prevalence of adverse pregnancy outcomes, providing evidence supporting new recommendations.
Keywords: gestational diabetes mellitusGDMglycemic targetspregnancy outcomesinsulin therapy
References
- IDF Diabetes Atlas | Tenth Edition. https://diabetesatlas.org/ (15.11.2023).
- Black MH, Sacks DA, Xiang AH, et al. Clinical outcomes of pregnancies complicated by mild gestational diabetes mellitus differ by combinations of abnormal oral glucose tolerance test values. Diabetes Care. 2010; 33(12): 2524–2530.
- Metzger BE, Lowe LP, Dyer AR, et al. HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358(19): 1991–2002.
- Buchanan TA, Xiang AH, Page KA. Gestational diabetes mellitus: risks and management during and after pregnancy. Nat Rev Endocrinol. 2012; 8(11): 639–649.
- Sweeting A, Wong J, Murphy HR, et al. A Clinical Update on Gestational Diabetes Mellitus. Endocr Rev. 2022; 43(5): 763–793.
- Crowther CA, Hiller JE, Moss JR, et al. Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005; 352(24): 2477–2486.
- Alwan N, Tuffnell DJ, West J. Treatments for gestational diabetes. Cochrane Database Syst Rev. 2009; 2009(3): CD003395.
- Prutsky GJ, Domecq JP, Wang Z, et al. Glucose targets in pregnant women with diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2013; 98(11): 4319–4324.
- Martis R, Brown J, Alsweiler J, et al. Different intensities of glycaemic control for women with gestational diabetes mellitus. Cochrane Database Syst Rev. 2016; 4(4): CD011624.
- PTD Z. 2017 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Clinical Diabetology. 2017; 6(A): 1–80.
- PTD Z. 2016 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Clinical Diabetology. 2016; 5(A).
- ElSayed NA, Aleppo G, Aroda VR, et al. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2023. Diabetes Care. 2023; 46(Suppl 1): S254–S266.
- Hofer OJ, Martis R, Alsweiler J, et al. Different intensities of glycaemic control for women with gestational diabetes mellitus. Cochrane Database Syst Rev. 2023; 10(10): CD011624.
- Hernandez TL. Glycemic targets in pregnancies affected by diabetes: historical perspective and future directions. Curr Diab Rep. 2015; 15(1): 565.
- de Veciana M, Major CA, Morgan MA, et al. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. N Engl J Med. 1995; 333(19): 1237–1241.
- Blumer I, Hadar E, Hadden DR, et al. Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2013; 98(11): 4227–4249.
- Overview | Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE. Published 202. https://www.nice.org.uk/guidance/ng3 (10.06.2023).
- Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007; 30 Suppl 2: S251–S260.
- Crowther CA, Samuel D, Hughes R, et al. TARGET Study Group. Tighter or less tight glycaemic targets for women with gestational diabetes mellitus for reducing maternal and perinatal morbidity: A stepped-wedge, cluster-randomised trial. PLoS Med. 2022; 19(9): e1004087.
- Żurawska-Kliś M, Czarnik K, Szymczak S, et al. 1-Hour postprandial glucose target of < 120 mg/dL is superior to < 140 mg/dL in the treatment for gestational diabetes mellitus in relation to pregnancy outcomes: A retrospective study. Acta Diabetol. 2021; 58(5): 665–668.
- Langer O. Glycemic targets for the optimal treatment of GDM. Clin Obstet Gynecol. 2013; 56(4): 788–802.
- White NH, Cleary PA, Dahms W, et al. Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group. Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). J Pediatr. 2001; 139(6): 804–812.
- King P, Peacock I, Donnelly R. The UK prospective diabetes study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol. 1999; 48(5): 643–648.
- Martis R, Crowther CA, Shepherd E, et al. Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2018; 8(8): CD012327.
- Araszkiewicz A, Bandurska-Stankiewicz E, Borys S, et al. 2023 Guidelines on the management of patients with diabetes - a position of Diabetes Poland. Current Topics in Diabetes. 2023; 3(1): 1–133.
- Barnes RA, Wong T, Ross GP, et al. A novel validated model for the prediction of insulin therapy initiation and adverse perinatal outcomes in women with gestational diabetes mellitus. Diabetologia. 2016; 59(11): 2331–2338.
- Mecacci F, Lisi F, Vannuccini S, et al. Different Gestational Diabetes Phenotypes: Which Insulin Regimen Fits Better? Front Endocrinol (Lausanne). 2021; 12: 630903.
- Thayer SM, Williams KJ, Lawlor ML. The role of technology in the care of diabetes mellitus in pregnancy: an expert review. AJOG Glob Rep. 2023; 3(3): 100245.
- Yu Qi, Aris IM, Tan KH, et al. Application and Utility of Continuous Glucose Monitoring in Pregnancy: A Systematic Review. Front Endocrinol (Lausanne). 2019; 10: 697.
- Eberle C, Loehnert M, Stichling S. Clinical Effectiveness of Different Technologies for Diabetes in Pregnancy: Systematic Literature Review. J Med Internet Res. 2021; 23(4): e24982.
- Tartaglione L, di Stasio E, Sirico A, et al. Continuous Glucose Monitoring in Women with Normal OGTT in Pregnancy. J Diabetes Res. 2021; 2021: 9987646.
- Turunen S, Vääräsmäki M, Leinonen M, et al. The Increased Trend of Medical Treatment for Thyroid Diseases during Pregnancy: A 13-Year National Study. Eur Thyroid J. 2021; 10(3): 230–236.
- Cho GJ, Kim LY, Sung YeNa, et al. Secular Trends of Gestational Diabetes Mellitus and Changes in Its Risk Factors. PLoS One. 2015; 10(8): e0136017.
- Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017; 27(3): 315–389.
- Hubalewska-Dydejczyk A, Lewiński A, Milewicz A, et al. [Management of thyroid diseases during pregnancy]. Endokrynol Pol. 2011; 62(4): 362–381.
