预测胰岛素治疗的需求:一种基于风险的妊娠期糖尿病妇女管理方法

IF 1.1 Q4 OBSTETRICS & GYNECOLOGY
Anna S. Koefoed, H. Mcintyre, K. Gibbons, C. W. Poulsen, J. Fuglsang, P. Ovesen
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引用次数: 0

摘要

妊娠期糖尿病(GDM)与不良妊娠结局相关,包括大胎龄婴儿。根据需要胰岛素的可能性对GDM妇女进行个体化管理可能会改善妊娠结局。本研究的目的是确定与GDM女性胰岛素需求相关的特征,并建立胰岛素需求的预测模型。2012年至2017年,在奥胡斯大学医院的所有单胎妊娠GDM女性中进行了一项历史队列研究。通过多变量logistic回归确定与胰岛素治疗相关的变量。这些变量被二分类,并纳入一个旨在预测需要胰岛素可能性的计分系统。七个变量与需要胰岛素相关:糖尿病家族史、当前吸烟者、多胎、孕前体重指数、口服葡萄糖耐量试验(OGTT)的胎龄、OGTT的2小时葡萄糖值和诊断时的血红蛋白A1c。计算风险评分,为每个变量赋一分。在ROC分析中,截断值≥3点是预测胰岛素需求的最佳值。该预测模型在进一步验证后可用于临床预测胰岛素治疗需求。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predicting the Need for Insulin Treatment: A Risk-Based Approach to the Management of Women with Gestational Diabetes Mellitus
Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes including large for gestational age infants. Individualizing the management of women with GDM based on the likelihood of needing insulin may improve pregnancy outcomes. The aim of this study is to identify characteristics associated with a need for insulin in women with GDM, and to develop a predictive model for insulin requirement. A historical cohort study was conducted among all women with GDM in a singleton pregnancy at Aarhus University Hospital from 2012 to 2017. Variables associated with insulin treatment were identified through multivariable logistic regression. The variables were dichotomized and included in a point scoring system aiming to predict the likelihood of needing insulin. Seven variables were associated with needing insulin: family history of diabetes, current smoker, multiparity, prepregnancy body mass index, gestational age at the oral glucose tolerance test (OGTT), 2-h glucose value at the OGTT and hemoglobin A1c at diagnosis. A risk score was calculated assigning one point to each variable. On ROC analysis, a cut-off value of ≥3 points optimally predicted a requirement for insulin. This prediction model may be clinically useful to predict requirement for insulin treatment after further validation.
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