A significant portion of pregnant women with Gestational Diabetes Mellitus (GDM) eventually requires insulin therapy, thus necessitating closer monitoring. In this study, we assessed a predictive model for the need of insulin therapy in women with GDM. In a retrospective cohort study, baseline data from 246 women with GDM (43% on subsequent insulin therapy, 57% on nutritional therapy alone) were analyzed using logistic regression. Diagnosis of GDM in previous pregnancies, previous GDM managed with insulin therapy, previous maternal impaired fasting glucose, fasting serum glucose diagnostic for GDM, and 0h and 2h diagnostic values at 75-g oral glucose tolerance test were independent qualitative significant predictors for subsequent insulin therapy. Pre-conceptional maternal body mass index, fasting serum glucose, HbA1c and gestational age at GDM diagnosis were independent quantitative significant predictors for subsequent insulin therapy. According to the odds ratios produced by the logistic regression, a risk score was developed, with identification of low (score <10, p <0.001) , moderate (score ≥and <14, p = 0.052) and high (score ≥14, p < 0.001) risk categories for need of insulin therapy during pregnancy. The area under the ROC curve (AUC) for the internal validation of the predictive model was 0.724. The risk assessment tool was then validated with an independent cohort of 22 GDM women, resulting in a similar predictive power (AUC = 0.744) . Thus, a simple risk score based on easily available clinical and biochemical data at the first visit can predict the need for insulin therapy in GDM women, leading to closer monitoring and timely initiation of therapy in pregnancies at higher risk.


M.Caporusso: Other Relationship; Eli Lilly and Company. L.Di gioia: Other Relationship; Eli Lilly and Company, Menarini Group. G.Sorice: None. A.Cignarelli: None. A.Natalicchio: Consultant; Novo Nordisk, Other Relationship; AstraZeneca, Lilly Diabetes, Sanofi. F.Giorgino: Advisory Panel; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk, Consultant; Lilly Diabetes, Sanofi, Research Support; Lilly Diabetes, Roche Diabetes Care, Takeda Pharmaceutical Company Limited. L.Laviola: Advisory Panel; Lilly Diabetes, Novo Nordisk, Roche Diabetes Care, Sanofi, Speaker's Bureau; A. Menarini Diagnostics, Abbott Diabetes, Medtronic, Terumo Corporation.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.