A predictive model for assessing the risk of having different subtypes of gestational diabetes mellitus

• Natalya I. Volkova
• Ilya Yu. Davidenko
• Yuliya А. Sorokina
• Yuliya S. Degtyareva
• Nadezhda D. Vlasova
• Darya O. Baeva

Abstract

A number of studies have demonstrated that the formation of gestational diabetes mellitus (GDM) may be based on both defects in insulin secretion and decreased insulin sensitivity, and therefore various pathogenetic subtypes of GDM are distinguished: with predominant β-cell dysfunction, with predominant insulin resistance (IR) and a mixed type. Previously, it was demonstrated that different subtypes have their own characteristics: anamnestic, phenotypic, biochemical, and also differ in the risk of complications. The determination of the GDM pathogenetic subtype is not only important scientific, but also practical, especially given the projected increase in the number of such patients.

Aim. To develop a model for assessing the risk of having various subtypes of GDM in pregnant women in order to prescribe pathogenetically justified therapy timely.

Material and methods. 130 pregnant women were examined. The patients were divided according to the results of the Matsuda index, that was calculated to evaluate the IR: group 1–45 pregnant women with GDM and β-cell dysfunction, group 2–43 pregnant women with GDM and IR, group 3–42 pregnant women without GDM (control). A questionnaire, a laboratory examination [diagnosis of GDM, lipid profile test, C reactive protein (CRP), adiponectin, omentin, leptin, apolipoproteins A and B] and an assessment of objective data were conducted. The following factors were studied: body mass index (BMI) before and during pregnancy, age, history of GDM, heredity, ethnicity and blood pressure, acanthosis nigricans, life history, reproductive history, and lifestyle factors.

Results and discussion. Multiple features of various GDM subtypes have been identified, and diagnostic models have been developed. A multiple regression equation was obtained between the indicators used in the developed model: increased values of the indicators «Weight», «Glucose 0», «Glucose 120», «CRP» increase the probability of having a subtype of GDM with pronounced IR [the area under the curve (AUC) is 98.79%, which indicates an extremely high predictive power of the model (the sensitivity of the model is 90%, the specificity is 98.28%)].

Conclusion. A mathematical model has been developed to identify GDM subtypes, which has an extremely high predictive power (98.79%) and meets the requirements for screening models.

Keywords:gestational diabetes mellitus; insulin resistance; pancreatic β-cell dysfunction; subtypes of gestational diabetes mellitus; diagnostic model

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