Friederike Weschenfelder1, Karolin Lohse2, Thomas Lehmann3, Ekkehard Schleußner1, Tanja Groten4. 1. Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany. 2. Unit Neonatology, Department of Paediatrics, University Hospital Jena, Jena, Germany. 3. Institute of Medical Statistics and Computer Science, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany. 4. Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany. tanja.groten@med.uni-jena.de.
Abstract
OBJECTIVE: Management of gestational diabetes (GDM) is currently changing toward a more personalized approach. There is a growing number of GDM patients requiring only a single dose of basal insulin at night to achieve glucose control. Well-known risk factors like obesity, parity and family history have been associated with GDM treatment requirements. Sleep quality and lifestyle factors interfering with the circadian rhythm are known to affect glucose metabolism. The aim of this study was to investigate the impact of such lifestyle factors on insulin requirement in GDM patients, in particular on long-acting insulin to control fasting glucose levels. RESEARCH DESIGN AND METHODS: A total of 805 patients treated for GDM between 2012 and 2016 received a study questionnaire on lifestyle conditions. Sleep quality and work condition categories were used for subgroup analysis. Independent effects on treatment approaches were evaluated using multivariate regression. RESULTS: In total, 235 (29.2%) questionnaires returned. Women reporting poor sleep conditions had higher pre-pregnancy weight and BMI, heavier newborns, more large for gestational age newborns and higher rates of hyperbilirubinemia. Treatment requirements were related to sleep and work condition categories. Multivariate regression for 'Basal' insulin-only treatment revealed an adjOR 3.4 (CI 1.23-9.40, p < 0.05) for unfavorable work conditions and adjOR 4.3 (CI 1.28-14.50, p < 0.05) for living with children. CONCLUSIONS: Our findings suggest that external stressors like unfavorable work conditions and living with children are independently associated with the necessity of long-acting insulin at night in GDM patients. Thus, fasting glucose levels of pregnant women presenting with such lifestyle conditions may be subject to close monitoring.
OBJECTIVE: Management of gestational diabetes (GDM) is currently changing toward a more personalized approach. There is a growing number of GDM patients requiring only a single dose of basal insulin at night to achieve glucose control. Well-known risk factors like obesity, parity and family history have been associated with GDM treatment requirements. Sleep quality and lifestyle factors interfering with the circadian rhythm are known to affect glucose metabolism. The aim of this study was to investigate the impact of such lifestyle factors on insulin requirement in GDM patients, in particular on long-acting insulin to control fasting glucose levels. RESEARCH DESIGN AND METHODS: A total of 805 patients treated for GDM between 2012 and 2016 received a study questionnaire on lifestyle conditions. Sleep quality and work condition categories were used for subgroup analysis. Independent effects on treatment approaches were evaluated using multivariate regression. RESULTS: In total, 235 (29.2%) questionnaires returned. Women reporting poor sleep conditions had higher pre-pregnancy weight and BMI, heavier newborns, more large for gestational age newborns and higher rates of hyperbilirubinemia. Treatment requirements were related to sleep and work condition categories. Multivariate regression for 'Basal' insulin-only treatment revealed an adjOR 3.4 (CI 1.23-9.40, p < 0.05) for unfavorable work conditions and adjOR 4.3 (CI 1.28-14.50, p < 0.05) for living with children. CONCLUSIONS: Our findings suggest that external stressors like unfavorable work conditions and living with children are independently associated with the necessity of long-acting insulin at night in GDM patients. Thus, fasting glucose levels of pregnant women presenting with such lifestyle conditions may be subject to close monitoring.
Authors: M Trento; F Broglio; F Riganti; M Basile; E Borgo; C Kucich; P Passera; P Tibaldi; M Tomelini; F Cavallo; E Ghigo; M Porta Journal: Acta Diabetol Date: 2008-08-07 Impact factor: 4.280