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264: Can fasting plasma glucose on the oral glucose tolerance test predict the success of diet therapy in gestational diabetes mellitus?
www.AJOG.org
Diabetes, Labor, Medical-Surgical-Disease, Obstetric Quality & Safety, Prematurity, Ultrasound-Imaging
Poster Session II
STUDY DESIGN: An observational study of women with GDM between
263 Patients with HgbA1C between 5.7– 6.4% at the first prenatal visit are 30 times more likely to develop GDM Lisa Moore1, Diana Clokey2 1 University of New Mexico, Obstetrics and Gynecology, Albuquerque, NM, 2University of New Mexico, OB/GYN, Albuquerque, NM
OBJECTIVE: In 2010 The American Diabetes Association (ADA) issued new guidelines for diagnosing diabetes in pregnancy. We sought to evaluate the use of the HgbA1C in the identification and management of patients with diabetes. STUDY DESIGN: A protocol implementing HgbA1C at the first prenatal visit was introduced. This is a retrospective review of the results. Patients with A1C ⱖ 6.5% (group 1) were given a diagnosis of diabetes and managed with diet and medication as needed. A1C between 5.76.4% (group 2) per protocol should have received a 75g glucose tolerance test (GTT) at 24-28 weeks however in practice a percentage of these patients received an early GTT or were started on daily monitoring of blood glucose. A1C ⬍5.7% (group 3) were given a GTT at the traditional 24-28 weeks. Only patients with first visit at ⬍ 20 weeks were included. Patients in groups 2 and 3 were labeled gestational diabetics(GDM) if they failed the GTT or failed to maintain euglycemia. RESULTS: 171 patients were identified. One patient miscarried at 12 weeks. There were 10 patients in group 1(5.9%), 45 in group 2(26.4%) and 115 in group 3(67.7%). All patients in group 1 required medication to achieve euglycemia. 34 patients(75.6%) in group 2 and 10 patients(8.7%) in group 3 were given a diagnosis of GDM (p⬍.0001). 24 of the 34 patients (71%) in group 2 diagnosed with GDM were identified prior to 24 weeks due to deviations from protocol described above. The odds ratio of having GDM with a HgbA1C in group 2 range was 29.9 (95%CI ⫽ 11-79.8). Mean BMI for groups 1,2 and 3 was 34.9, 31.6, and 28.7 respectively. The difference in mean BMI reached significance between groups 2 and 3 (P⫽.04) and between groups 1 and 3 (P⫽.014). Controlling for HgbA1C in groups 2 and 3, a BMI ⱖ30 was an independent risk factor for GDM. Adjusted odds ratio 3.5 (95% CI ⫽1.3-9.4). CONCLUSION: Patients with a HgbA1C between 5.7-6.4 are 30 times more likely to develop GDM. This group may benefit from early testing and intervention for GDM. Patients with a BMI ⱖ30 are 3.5 times more likely to develop GDM regardless of HgbA1C.
2007 and 2010. On initial visit patients were counseled on diet therapy, self-monitoring blood glucose (SMBG) and instructed to test 4 to 7 times daily. Patients with an OFPG ⬍95 mg/dl were included in this study and assigned to diet therapy. SMBG data was downloaded from glucose meters and analyzed at 2 week intervals. Targeted glycemic control was: mean fasting glucose (FBG) ⬍95 mg/dl, mean pre-meal (PMG) ⬍100 mg/dl, mean 2-hour post-meal (2HRG) ⬍120 mg/dl and overall mean blood glucose (MBG) ⬍105 mg/dl. If one or more of these targeted levels were not achieved the patient was transferred to pharmacologic therapy (glyburide or insulin). Patients were stratified into groups (G) based on OFPG: G1 55-74 mg/dl; G2 75-84 mg/dl; G3 85-94 mg/dl. Fisher’s exact test and ANOVA were used for statistical analysis. RESULTS: 1007 GDM patients were identified in the study period; 817 had OFPG 90%ile (LGA) in these groups. The graph below displays the comparison of the overall need for pharmacologic therapy in patients with an OFPG ⬍95mg/dl vs. the need for therapy in the initial 2 weeks. Overall, 31% of the patients required pharmacologic therapy during pregnancy. Of these 53.9% were identified in the initial 2 week evaluation. CONCLUSION: Our data suggest that even patients with OFPG of ⬍95mg/dl, at various thresholds will require pharmacologic therapy. Therefore, SMBG needs to be utilized to identify patients for whom diet alone does not achieve targeted levels of glycemic control.
264 Can fasting plasma glucose on the oral glucose tolerance test predict the success of diet therapy in gestational diabetes mellitus? Lois Brustman1, Sophia Scarpelli-Havraniak1, Orli Most2, Benjamin Lust1, Oded Langer1 1
St. Luke’s Roosevelt Hospital Center, Ob/Gyn, New York, NY, Morristown Memorial Hospital, Ob/Gyn, Morristown, NJ
2
OBJECTIVE: Evaluate the need for pharmacologic therapy in gestational diabetes (GDM) based on the oral glucose tolerance test fasting plasma glucose (OFPG). Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology
S129
Diabetes, Labor, Medical-Surgical-Disease, Obstetric Quality & Safety, Prematurity, Ultrasound-Imaging
Poster Session II
STUDY DESIGN: An observational study of women with GDM between
263 Patients with HgbA1C between 5.7– 6.4% at the first prenatal visit are 30 times more likely to develop GDM Lisa Moore1, Diana Clokey2 1 University of New Mexico, Obstetrics and Gynecology, Albuquerque, NM, 2University of New Mexico, OB/GYN, Albuquerque, NM
OBJECTIVE: In 2010 The American Diabetes Association (ADA) issued new guidelines for diagnosing diabetes in pregnancy. We sought to evaluate the use of the HgbA1C in the identification and management of patients with diabetes. STUDY DESIGN: A protocol implementing HgbA1C at the first prenatal visit was introduced. This is a retrospective review of the results. Patients with A1C ⱖ 6.5% (group 1) were given a diagnosis of diabetes and managed with diet and medication as needed. A1C between 5.76.4% (group 2) per protocol should have received a 75g glucose tolerance test (GTT) at 24-28 weeks however in practice a percentage of these patients received an early GTT or were started on daily monitoring of blood glucose. A1C ⬍5.7% (group 3) were given a GTT at the traditional 24-28 weeks. Only patients with first visit at ⬍ 20 weeks were included. Patients in groups 2 and 3 were labeled gestational diabetics(GDM) if they failed the GTT or failed to maintain euglycemia. RESULTS: 171 patients were identified. One patient miscarried at 12 weeks. There were 10 patients in group 1(5.9%), 45 in group 2(26.4%) and 115 in group 3(67.7%). All patients in group 1 required medication to achieve euglycemia. 34 patients(75.6%) in group 2 and 10 patients(8.7%) in group 3 were given a diagnosis of GDM (p⬍.0001). 24 of the 34 patients (71%) in group 2 diagnosed with GDM were identified prior to 24 weeks due to deviations from protocol described above. The odds ratio of having GDM with a HgbA1C in group 2 range was 29.9 (95%CI ⫽ 11-79.8). Mean BMI for groups 1,2 and 3 was 34.9, 31.6, and 28.7 respectively. The difference in mean BMI reached significance between groups 2 and 3 (P⫽.04) and between groups 1 and 3 (P⫽.014). Controlling for HgbA1C in groups 2 and 3, a BMI ⱖ30 was an independent risk factor for GDM. Adjusted odds ratio 3.5 (95% CI ⫽1.3-9.4). CONCLUSION: Patients with a HgbA1C between 5.7-6.4 are 30 times more likely to develop GDM. This group may benefit from early testing and intervention for GDM. Patients with a BMI ⱖ30 are 3.5 times more likely to develop GDM regardless of HgbA1C.
2007 and 2010. On initial visit patients were counseled on diet therapy, self-monitoring blood glucose (SMBG) and instructed to test 4 to 7 times daily. Patients with an OFPG ⬍95 mg/dl were included in this study and assigned to diet therapy. SMBG data was downloaded from glucose meters and analyzed at 2 week intervals. Targeted glycemic control was: mean fasting glucose (FBG) ⬍95 mg/dl, mean pre-meal (PMG) ⬍100 mg/dl, mean 2-hour post-meal (2HRG) ⬍120 mg/dl and overall mean blood glucose (MBG) ⬍105 mg/dl. If one or more of these targeted levels were not achieved the patient was transferred to pharmacologic therapy (glyburide or insulin). Patients were stratified into groups (G) based on OFPG: G1 55-74 mg/dl; G2 75-84 mg/dl; G3 85-94 mg/dl. Fisher’s exact test and ANOVA were used for statistical analysis. RESULTS: 1007 GDM patients were identified in the study period; 817 had OFPG 90%ile (LGA) in these groups. The graph below displays the comparison of the overall need for pharmacologic therapy in patients with an OFPG ⬍95mg/dl vs. the need for therapy in the initial 2 weeks. Overall, 31% of the patients required pharmacologic therapy during pregnancy. Of these 53.9% were identified in the initial 2 week evaluation. CONCLUSION: Our data suggest that even patients with OFPG of ⬍95mg/dl, at various thresholds will require pharmacologic therapy. Therefore, SMBG needs to be utilized to identify patients for whom diet alone does not achieve targeted levels of glycemic control.
264 Can fasting plasma glucose on the oral glucose tolerance test predict the success of diet therapy in gestational diabetes mellitus? Lois Brustman1, Sophia Scarpelli-Havraniak1, Orli Most2, Benjamin Lust1, Oded Langer1 1
St. Luke’s Roosevelt Hospital Center, Ob/Gyn, New York, NY, Morristown Memorial Hospital, Ob/Gyn, Morristown, NJ
2
OBJECTIVE: Evaluate the need for pharmacologic therapy in gestational diabetes (GDM) based on the oral glucose tolerance test fasting plasma glucose (OFPG). Supplement to JANUARY 2012 American Journal of Obstetrics & Gynecology
S129