Glucagon change rate after glucose load: a potential key for tailoring treatment in gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is a known risk factor for both maternal and fatal complications. Glycemic control in pregnant women is important for preventing these complications. However, the need for insulin therapy in pregnant women is difficult to determine. This study focuses on glucagon, which provides new prospects due to advancement in the measurement assay method for type 2 diabetes. Investigating the dynamics of glucagon in pregnant women will help in the diagnosis of GDM and in identifying those requiring insulin treatment. A total of 58 pregnant women between 24 and 31 weeks of gestation underwent a 75-g glucose tolerance test at our institution between 2013 and 2015. The results showed differences in post-glucose and insulin levels between patients with and without GDM, but not in glucagon levels. However, differences were observed in fasting plasma glucose (79.2 ± 4.2 vs. 85.7 ± 8.5 mg/dL, P = 0.006) and in the glucagon change rates at 15, 30, and 60 min after glucose loading between patients with GDM requiring insulin treatment and those who did not. Using a cutoff value of -0.4566 for the glucagon change rate at 60 min as the predictor for insulin treatment, the sensitivity and specificity were 63.16% and 92.31%, respectively. Overall, the measurement of glucagon during the early post-glucose load period may be useful in predicting insulin therapy requirements in pregnant Asian women with GDM.

The online version contains supplementary material available at 10.1007/s13340-025-00797-y.