Endocrine Abstracts

Introduction: Gestational diabetes mellitus (GDM) arises from elevated glycemia during pregnancy, posing risks to both mother and fetus. Managing GDM involves close monitoring and dietary control, with antenatal insulin therapy (AIT). The aim of this study was to evaluate the efficiency of diverse maternal characteristics and biological indicators identified during GDM diagnosis in anticipating the inadequacy of dietary measures and the requirement for AIT to achieve glucose targets.

Materials: We conducted a retrospective longitudinal study that included women diagnosed with GDM and who were monitored at the Endocrinology Department of Farhad Hached Hospital in Sousse between January 2017 and March 2020.

Results: We analyzed 380 records of patients diagnosed with GDM. The average age in our patient group was 34 ± 5 years, ranging from 20 to 46 years. Among them, 73% (280 individuals) needed AIT, while 100 patients achieved glycemic goals solely through Medical Nutrition Therapy (MNT). Notably, those requiring insulin had prior history of obesity (24%), gestational diabetes (12%), and macrosomia (18%) (P=10^-3). Patients meeting glycemic targets via MNT had higher total carbohydrate intake upon GDM diagnosis (P=0.02). Those necessitating AIT were diagnosed at an average gestational age (GA) of 24±6 weeks, significantly earlier than the 25±6 weeks observed in patients following MNT (P<10^-3). Fasting glucose levels did not exhibit a notable difference between the two groups. Patients requiring insulin showed a median HbA1c level of 5.5%, surpassing levels observed in the group under MNT. Elevated HbA1C emerged as the only independent predictor for the necessity of AIT.

Conclusion: Recognizing the diverse spectrum of glucose intolerance severity among women with GDM necessitates a stratified classification for management strategies. This approach allows for the optimal allocation of human and financial resources. Notably, a higher HbA1C at diagnosis signals the potential need for intensified monitoring by specialized healthcare providers.