Rationale for insulin management in gestational diabetes mellitus

Oded Langer, Michael D Berkus, Lois Brustman, Akolisa Anyaegbunam, Roger Mazze

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

A prospective study was undertaken to test the hypothesis that insulin treatment in patients with gestational diabetes mellitus (GDM) with fasting plasma glucose (FPG) >5.3 mM significantly reduces adverse perinatal outcome. Assigned to insulin or diet treatment based on FPG were 471 GDM women. Four factors believed to be associated with infants large for gestational age (LGA) were evaluated FPG, overall glycemic control, maternal weight, and treatment regimen. We found that when glycemic control was optimized, the key factors related to large infants were FPG and treatment modality. In the low-FPG group (<5.3 mM), diet therapy achieved an incidence of 5.3% LGA. When insulin therapy was used to optimize control, an incidence of 3.5% LGA was found. Patients in the mid-FPG group (5.3-5.8 mM) had a higher increased rate of LGA (28.6%) for diet-treated versus insulin-treated women (10.3%). In addition, a fourfold increased risk for LGA was found in the diet-treated obese subjects in the mid-FPG group compared with insulin-treated obese women. Finally, treatment with insulin resulted in similar incidence of LGA within all FPG groups. We concluded that FPG >5.3 mM can be the basis for initiation of insulin treatment in GDM subjects with optimization of glycemic control as the goal. This approach may contribute significantly to reduced neonatal risk and may foster a standardized method for rapid and effective assignment to treatment.

Original languageEnglish (US)
Pages (from-to)186-190
Number of pages5
JournalDiabetes
Volume40
Issue numberSUPPL. 2
StatePublished - 1991
Externally publishedYes

Fingerprint

Gestational Diabetes
Fasting
Insulin
Glucose
Therapeutics
Gestational Age
Mothers
Prospective Studies
Diet
Weights and Measures

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

Cite this

Langer, O., Berkus, M. D., Brustman, L., Anyaegbunam, A., & Mazze, R. (1991). Rationale for insulin management in gestational diabetes mellitus. Diabetes, 40(SUPPL. 2), 186-190.

Rationale for insulin management in gestational diabetes mellitus. / Langer, Oded; Berkus, Michael D; Brustman, Lois; Anyaegbunam, Akolisa; Mazze, Roger.

In: Diabetes, Vol. 40, No. SUPPL. 2, 1991, p. 186-190.

Research output: Contribution to journalArticle

Langer, O, Berkus, MD, Brustman, L, Anyaegbunam, A & Mazze, R 1991, 'Rationale for insulin management in gestational diabetes mellitus', Diabetes, vol. 40, no. SUPPL. 2, pp. 186-190.
Langer O, Berkus MD, Brustman L, Anyaegbunam A, Mazze R. Rationale for insulin management in gestational diabetes mellitus. Diabetes. 1991;40(SUPPL. 2):186-190.
Langer, Oded ; Berkus, Michael D ; Brustman, Lois ; Anyaegbunam, Akolisa ; Mazze, Roger. / Rationale for insulin management in gestational diabetes mellitus. In: Diabetes. 1991 ; Vol. 40, No. SUPPL. 2. pp. 186-190.
@article{cf464bc0089b4966b51b4ca96e6f5325,
title = "Rationale for insulin management in gestational diabetes mellitus",
abstract = "A prospective study was undertaken to test the hypothesis that insulin treatment in patients with gestational diabetes mellitus (GDM) with fasting plasma glucose (FPG) >5.3 mM significantly reduces adverse perinatal outcome. Assigned to insulin or diet treatment based on FPG were 471 GDM women. Four factors believed to be associated with infants large for gestational age (LGA) were evaluated FPG, overall glycemic control, maternal weight, and treatment regimen. We found that when glycemic control was optimized, the key factors related to large infants were FPG and treatment modality. In the low-FPG group (<5.3 mM), diet therapy achieved an incidence of 5.3{\%} LGA. When insulin therapy was used to optimize control, an incidence of 3.5{\%} LGA was found. Patients in the mid-FPG group (5.3-5.8 mM) had a higher increased rate of LGA (28.6{\%}) for diet-treated versus insulin-treated women (10.3{\%}). In addition, a fourfold increased risk for LGA was found in the diet-treated obese subjects in the mid-FPG group compared with insulin-treated obese women. Finally, treatment with insulin resulted in similar incidence of LGA within all FPG groups. We concluded that FPG >5.3 mM can be the basis for initiation of insulin treatment in GDM subjects with optimization of glycemic control as the goal. This approach may contribute significantly to reduced neonatal risk and may foster a standardized method for rapid and effective assignment to treatment.",
author = "Oded Langer and Berkus, {Michael D} and Lois Brustman and Akolisa Anyaegbunam and Roger Mazze",
year = "1991",
language = "English (US)",
volume = "40",
pages = "186--190",
journal = "Diabetes",
issn = "0012-1797",
publisher = "American Diabetes Association Inc.",
number = "SUPPL. 2",

}

TY - JOUR

T1 - Rationale for insulin management in gestational diabetes mellitus

AU - Langer, Oded

AU - Berkus, Michael D

AU - Brustman, Lois

AU - Anyaegbunam, Akolisa

AU - Mazze, Roger

PY - 1991

Y1 - 1991

N2 - A prospective study was undertaken to test the hypothesis that insulin treatment in patients with gestational diabetes mellitus (GDM) with fasting plasma glucose (FPG) >5.3 mM significantly reduces adverse perinatal outcome. Assigned to insulin or diet treatment based on FPG were 471 GDM women. Four factors believed to be associated with infants large for gestational age (LGA) were evaluated FPG, overall glycemic control, maternal weight, and treatment regimen. We found that when glycemic control was optimized, the key factors related to large infants were FPG and treatment modality. In the low-FPG group (<5.3 mM), diet therapy achieved an incidence of 5.3% LGA. When insulin therapy was used to optimize control, an incidence of 3.5% LGA was found. Patients in the mid-FPG group (5.3-5.8 mM) had a higher increased rate of LGA (28.6%) for diet-treated versus insulin-treated women (10.3%). In addition, a fourfold increased risk for LGA was found in the diet-treated obese subjects in the mid-FPG group compared with insulin-treated obese women. Finally, treatment with insulin resulted in similar incidence of LGA within all FPG groups. We concluded that FPG >5.3 mM can be the basis for initiation of insulin treatment in GDM subjects with optimization of glycemic control as the goal. This approach may contribute significantly to reduced neonatal risk and may foster a standardized method for rapid and effective assignment to treatment.

AB - A prospective study was undertaken to test the hypothesis that insulin treatment in patients with gestational diabetes mellitus (GDM) with fasting plasma glucose (FPG) >5.3 mM significantly reduces adverse perinatal outcome. Assigned to insulin or diet treatment based on FPG were 471 GDM women. Four factors believed to be associated with infants large for gestational age (LGA) were evaluated FPG, overall glycemic control, maternal weight, and treatment regimen. We found that when glycemic control was optimized, the key factors related to large infants were FPG and treatment modality. In the low-FPG group (<5.3 mM), diet therapy achieved an incidence of 5.3% LGA. When insulin therapy was used to optimize control, an incidence of 3.5% LGA was found. Patients in the mid-FPG group (5.3-5.8 mM) had a higher increased rate of LGA (28.6%) for diet-treated versus insulin-treated women (10.3%). In addition, a fourfold increased risk for LGA was found in the diet-treated obese subjects in the mid-FPG group compared with insulin-treated obese women. Finally, treatment with insulin resulted in similar incidence of LGA within all FPG groups. We concluded that FPG >5.3 mM can be the basis for initiation of insulin treatment in GDM subjects with optimization of glycemic control as the goal. This approach may contribute significantly to reduced neonatal risk and may foster a standardized method for rapid and effective assignment to treatment.

UR - http://www.scopus.com/inward/record.url?scp=0026338586&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026338586&partnerID=8YFLogxK

M3 - Article

C2 - 1748257

AN - SCOPUS:0026338586

VL - 40

SP - 186

EP - 190

JO - Diabetes

JF - Diabetes

SN - 0012-1797

IS - SUPPL. 2

ER -