Gestational diabetes mellitus represents a condition characterised by glucose intolerance first recognised during pregnancy, without being overt diabetes. It is the most common metabolic disorder and the most frequent medical complication during pregnancy, with an estimated 2 to 9 per cent of pregnancies worldwide being affected.
In Germany, the proportion of GDM increased from 4.6 per cent of all hospital births in 2013 to 6.8 per cent in 2018. This trend can also be seen in other Western countries and could correlate with higher obesity rates and an older average age at conception. According to data provided by the Association of Diabetes Physicians, every year in Italy about 40,000 pregnancies are complicated by diabetes.
GDM usually disappears after delivery, but it is a significant risk factor for the future development of type 2 diabetes, with some studies estimating a risk of up to 30% after GDM. GDM is associated with various perinatal complications for the mother and fetus/infant (pre-eclampsia, miscarriage, fetal abnormalities and macrosomia, caesarean section and neonatal hypoglycaemia).
The extent of maternal-fetal health effects is mainly determined by the severity of the disease, generally classified as moderate or severe (insulin-dependent GDM). The distinction between the two types of GDM progression is essential not only to provide the correct treatment, but also to choose the correct patient management strategy (appointment frequency, interventional therapy, delivery planning).
Proper monitoring and treatment of gestational diabetes may improve perinatal outcomes. However, it may be difficult to predict the course of the disease on the basis of the first consultation and oral glucose load curves commonly performed today.
The study recently published in the Journal of Clinical Medicine used data from the Charité from January 2015 to December 2022. The final cohort included 1611 patients with single pregnancies, pathological response to the 75g Oral Glucose Tolerance Test (OGTT) and subsequent delivery at the Berlin Charité. 77.5% were diagnosed with moderate GDM, 22.5% with insulin-dependent GDM.
The CHarité AssessmeNt of GEstational Diabetes (CHANGED) Score showed a high predictive accuracy in identifying insulin-dependent gestational diabetes, with an area under the curve (AUC) of 0.77. This indicates that the model is effective in distinguishing between high and low risk patients. Such accuracy is crucial in optimising the management and treatment of patients with gestational diabetes, allowing for more timely and targeted intervention.
The CHANGED Score is based on several key factors that influence the prediction of insulin dependence in gestational diabetes. Fasting glycaemic level, pre-pregnancy BMI, and maternal age were especially significant. In particular, high fasting blood glucose values above 106 mg/dL, a pre-pregnancy BMI above 33.2 and an advanced maternal age were associated with higher scores in the predictive model. Compared to other predictive instruments, the CHANGED Score is simpler and more practical than other methods, according to the study authors.
The implementation of the CHANGED Score in clinical practice could revolutionise the approach to the management of gestational diabetes. Identifying patients at risk of insulin dependence at an early stage allows more accurate tailoring of treatment plans and closer monitoring. This targeted approach could reduce the risk of maternal-fetal complications and improve overall perinatal outcomes.
Despite the encouraging results, the researchers point out that the CHANGED Score was developed and validated in the context of specific conditions, on a specific cohort of patients, at a single facility.
Its applicability in different clinical settings requires further validation studies on larger and more diverse populations. External validation of the CHANGED Score is crucial to ensure its adaptability to different clinical settings. Furthermore, future research could explore the effect of model implementation on clinical practice and long-term maternal-fetal outcomes.