Objective: We investigated efficacy of the risk category system in the triage of patients to insulin therapy in a prospective cohort of women with gestational diabetes (GDM).
Study Design: In a previous retrospective study, we developed a risk category system for insulin therapy (≥20 U/day), in which we found two risk factors including prepregnancy BMI ≥24 and fasting plasma glucose ≥84 mg/dl. In the current study, we investigated the validity of the risk categories for triage to insulin therapy in a new prospective cohort. We included women with GDM diagnosed at 24-32 weeks of gestation according to the IADPSG criteria in a single tertiary perinatal care center between June 2015 and March 2018. After the diagnosis, all patients underwent self-monitoring of blood glucose (SMBG) under nutrition therapy. Insulin therapy was indicated, if SMBG did not achieve 80% of the target glucose values. Multivariate analysis adjusted for confounders were performed to examine the association between risk categories and insulin therapy (≥20 U/day and ≥30 U/day).
Results: Among 240 patients with GDM, 119 (50%) had at least one risk category. Insulin therapy ≥20 U/day and ≥30 U/day was indicated in 86 (35.8%) and 61 (25.4%) patients, respectively. In comparison to women without risk factor, patients with at least one risk factor were significantly at risk for insulin therapy ≥20 and ≥30 U/day with adjusted odds ratio of 3.8 (95%CI 1.7-8.7) and 16.4 (4.9-75.6), PPV of 0.51 and 0.39, and NPV of 0.79 and 0.88, respectively.
Conclusion: With keeping SMBG triage first, the risk category system seems to be effective, especially for the triage of patients without risk categories to less intensive care, because of the high negative predictive value.
H. Yamashita: None. I. Yasuhi: None. S. Suga: None. S. Isokawa: None. M. Fukuoka: None. M. Koga: None. J. Yamaguchi: None. S. Sugimi: None. Y. Umezaki: None. M. Fukuda: None. N. Kusuda: None.