[The significance of 75 g oral glucose tolerance test (OGTT) and clinical characteristics of gestational diabetes mellitus patients requiring different therapeutic approaches].

Gestational diabetes mellitus (GDM) constitutes emerging medical problem with incidence rate on the rise all over the world. Thus, it is important to define characteristics of affected individuals. The aim of the study was to analyse the test results of oral load of 75g of glucose as a predictor of need for insulin in the treatment of gestational diabetes and to provide 2nd trimester characteristics of women eventually requiring insulin as compared with those in behavioural approach was sufficient. Material and Methods: We analysed medical records of 203 consecutive women with diagnosis of GDM (mean age 31.4+/- 4.7 years, BMI before pregnancy, 24.5+/- 4.8 kg/m2). The basis for diagnosis of GDM was the result of the OGTT with 75g of glucose, based on the Polish Diabetic Society guidelines (fasting glucose (FPG)> 5.6 mmol/l and/or glucose in 120 'of OGTT> 7.8 mmol/l). We compared patients who required insulin with those treated with diet only. Results: 82 patients (40% of the study group) required implementation of insulin while the other patients remained on diet only. Women requiring insulin therapy reported to the clinic in the earlier gestation's week (p= 0.018) and had higher BMI before pregnancy (p=0.01); also in 75g glucose OGTT obtained significantly higher FPG level (p=0.001) in compare to the diettreated group. Univariate linear regression analysis confirmed a significant, negative correlation between FPG and the week of pregnancy to implement insulin, in the studied group (R=-0.22; p=0.045). Our study showed that the 75g glucose OGTT might have predictive value in choosing insulin treatment in gestational diabetes. We showed that there are differences in the clinical picture between GDM requiring different therapeutic approaches. Our work confirmed also previous reports that higher BMI before pregnancy, an earlier week of diagnosis of the GDM are the risk factors for insulin therapy during pregnancy.