Therapeutic characteristics of patients with gestational diabetes mellitus receiving insulin treatment during pregnancy: a retrospective study

Aims: To explore the therapeutic characteristics of gestational diabetes mellitus (GDM) patients receiving insulin therapy during pregnancy. Methods: In this retrospective study, 790 GDM patients from Shanghai General Hospital were enrolled. Information consisting of demographic and laboratory data, the insulin treatment protocol, and daily insulin dosage before delivery were collected. Results: A total of 236 (29.87%) GDM patients received insulin treatment. Fasting plasma glucose (FPG), 1-hour plasma glucose (1hPG), HbA1c, and gestational week at diagnosis were associated with insulin treatment. The average daily insulin dosages were 0.15, 0.27, 0.29, and 0.50 U/kg, from once daily to four daily injections, while insulin pump users received 0.62 U/kg ( P for trend<0.001). FPG, 1hPG, and HbA1c at diagnosis showed significant value for predicting the need for four daily insulin injectionsbefore delivery in ROC analysis (all P <0.001), and the cut-off values were 5.6 mmol/L, 10.4 mmol/L, and 5.7%. The AUC for the model considering FPG, 1hPG, and HbA1c together was larger than that of any single variable (all P <0.05). Conclusion: The average daily insulin dosage before delivery increased with the frequency of insulin injections. Patients with FPG ³5.6 mmol/L, 1hPG ³10.4 mmol/L, and HbA1c ³5.7% at diagnosis required intensive insulin therapy before delivery.