Endocrine Abstracts

Introduction: Gestational diabetes’ (GDM) intensive management of with adequate insulin therapy prevents maternal, fetal and neonatal complications associated with hyperglycaemia.

Objective: Identify predictive factors for starting insulin in gestational diabetes’ management.

Methods: We report a retrospective study conducted from January 2010 to December 2016, involving 191 patients followed in the Endocrinology - Diabetology Department of Ibn Rochd University Hospital of Casablanca for gestational diabetes. The parameters studied were: age, gestational diabetes’ recurrence, family history of diabetes, pre-gestational BMI, term of pregnancy at the time of GDM’s discovery, initial fasting glucose level and the treatment adopted. Statistical analysis was univariate for all the variables using SPSS version 22.0.0.

Results: Mean age of our patients was 32.5±6.4 years, mean pre-pregnancy BMI 27.7±3.9 kg/m². A history of gestational diabetes was found in 14% of pregnant women and macrosomia in 19%. Average term of discovery of the CEO was 23±9.2 SA. Treatment consisted of diet alone in 29% of our patients, insulin therapy in 71%, with a basal regimen in 31% of cases, a basal-plus in 26% and a basal bolus in 43%. Average insulin dose was 0.51 IU/kg/day. Insulin therapy was more frequent when age was greater than 35 years (P=0.01), gestational diabetes’ discovery term was early (<25 weeks) (P=0.02), and initial fasting glucose levels was high (>1.26 g/l) (P=0.01). Personal history of macrosomia, gestational diabetes, and overweight were frequently associated with insulin-dependent patients, with no statistically significant relationship.

Discussion: Our results indicates a strong reliance on insulin-therapy in our population, especially since gestational diabetes’ term of discovery is early, age is advanced and initial fasting glucose level is high. However, overweight and gestational diabetes history did not have a significant impact.

Conclusion: Insulin initiation predictive factors are important to identify. It is an important step in the management of gestational diabetes to improve maternal and fetal prognosis through close monitoring and rigorous follow-up.