The need for pharmacotherapy among patients with one or more elevations on glucose tolerance test

To identify factors associated with need for pharmacotherapy among patients with glucose intolerance and 1 elevation on 3-hour oral glucose tolerance test (OGTT).

Retrospective cohort study of singleton gestations 24 weeks or greater with at least 1 elevation on OGTT. The primary outcome was need for pharmacotherapy for glycemic control. To evaluate timing of OGTT elevation with need for pharmacotherapy, a logistic regression model controlled for maternal race/ethnicity, body mass index (BMI), gestational age at time of OGTT, age, parity, history of gestational diabetes, and history of large neonate. The need for pharmacotherapy was assessed based on number and extent of testing elevations. A predictive model based on linear discriminant analysis was developed.

Overall, 480 patients had 1 OGTT elevation; of these, 19.2% required pharmacotherapy. Fasting elevations were most associated with development of medication-requiring diabetes. A predictive model for risk of pharmacotherapy in patients with an abnormal OGTT based on BMI and extent of elevation at each OGTT time point increased the identification of patients requiring pharmacotherapy by 15.4%. At least 2 OGTT elevations occurred in 376 patients; these patients were more likely to require pharmacotherapy for glycemic control compared to those with 1 elevation. Patients with increasing BMI values had increased need for pharmacotherapy regardless of the number of abnormal values.

Among patients with 1 OGTT elevation, fasting elevation and BMI are predictive of need for anti-glycemic medications. Predictive models may be useful in assessing need for pharmacotherapy for patients with abnormal OGTT, not otherwise meeting criteria for gestational diabetes.