Variabilidad glucémica al diagnóstico de diabetes gestacional como predictor de tratamiento farmacológico

Introduction

To establish whether glycemic variability (GV) parameters used when gestational diabetes mellitus (GDM) has been diagnosed could help predict the probability that a patient will need pharmacological treatment, and to analyze the link of these parameters to the development of maternal-fetal complications.

Materials and methods

A prospective study of 87 women with GDM who underwent retrospective continuous glucose monitoring (CGM) for 6 days between weeks 26 and 32 of gestation, following diagnosis. The mean glycemia levels and GV variables were analyzed together with their link to maternal-fetal complications, and the need for pharmacological treatment. ROC (receiver operating characteristic) curves were developed to determine validity to detect the need for pharmacological treatment.

Results

Patients with higher mean glycemia (P < 0.001) and continuous overlapping of net glycemic action in a period of n-hours (CONGAn) (P = 0.001) required pharmacological treatment. The ROC curves showed cut-off points of 98.81 mg/dl for mean glycemia, and 86.70 mg/dl for CONGAn, with 83.3% sensitivity and 67.8% specificity for both parameters. No relation between the GV parameters and development of maternal-fetal complications was observed.

Conclusions

The use of CGM, once GDM is diagnosed, enables us to identify those patients who would benefit from closer monitoring during gestation, and facilitate a speedier take-up of pharmacological treatment. However, prospective studies involving a higher number of patients are needed, as well as a cost assessment for recommending the use of CGM following GDM diagnosis.