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Different Gestational Diabetes Phenotypes: Which Insulin Regimen Fits Better?
Federico Mecacci1,2, Federica Lisi1, Silvia Vannuccini2,3
1Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Careggi University Hospital, Florence, Italy.
Frontiers in Endocrinology
|March 26, 2021
Summary
Identifying maternal phenotypes helps personalize gestational diabetes mellitus (GDM) treatment. Specific factors predict the need for insulin therapy and the type of insulin analogues required for optimal glycemic control.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Metabolic Disorders
Background:
- Gestational diabetes mellitus (GDM) requires tailored treatment strategies.
- Personalizing GDM management is crucial for maternal and fetal outcomes.
- Understanding maternal phenotypes can guide treatment decisions.
Purpose of the Study:
- To evaluate maternal characteristics and OGTT values in GDM pregnancies.
- To identify distinct maternal phenotypes based on treatment strategies.
- To predict appropriate treatment for GDM.
Main Methods:
- Retrospective study of 1,974 pregnant women with GDM.
- Comparison of nutritional therapy alone versus nutritional therapy with insulin analogues.
- Analysis of different insulin analogue regimens (long-acting, rapid-acting, combined).
Main Results:
- 51.3% of women required insulin therapy.
- Maternal factors like age >35, BMI >30, family history, previous GDM, altered FPG, hypothyroidism, and ART predicted insulin need.
- Altered OGTT glucose levels, age >35, and previous GDM predicted combined insulin therapy.
- Low pre-pregnancy BMI (<25) and normal FPG predicted rapid-acting insulin analogue use only.
Conclusions:
- Maternal and metabolic variables at GDM diagnosis can identify distinct phenotypes.
- Personalized treatment for GDM can be achieved by identifying these phenotypes.
- This approach aims for optimized glycemic control in GDM.
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