{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T07:48:26Z","timestamp":1772869706965,"version":"3.50.1"},"reference-count":18,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T00:00:00Z","timestamp":1726704000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Diabetes Invest"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Aims\/Introduction<\/jats:title><jats:p>This study evaluated the risk factors for insulin therapy before 24 gestational weeks (early insulin therapy) in pregnant women with gestational diabetes diagnosed before 24 gestational weeks (E\u2010GDM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>This study included 530 singleton mothers with E\u2010GDM who underwent a 75\u2009g oral glucose tolerance test (OGTT) in the first trimester at Keio University Hospital between January 2013 and December 2021. E\u2010GDM can be classified according to its management into only diet therapy until delivery (Diet E\u2010GDM), insulin therapy started before 24 gestational weeks (EarlyIns E\u2010GDM), and insulin therapy started after 24 gestational weeks (LateIns E\u2010GDM). We analyzed the risk factors for EarlyIns E\u2010GDM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with EarlyIns E\u2010GDM had a significantly higher maternal age at delivery, pre\u2010pregnancy BMI, first trimester hemoglobin A1c, 1 h plasma glucose levels (1\u2009h\u2010PG), and 2\u2009h\u2010PG, as well as a more pronounced initial increase and subsequent decrease, compared with those in the Diet E\u2010GDM group. However, the Apgar scores at both 1 and 5\u2009min were significantly lower in patients with EarlyIns E\u2010GDM than in those with Diet E\u2010GDM. The number of abnormal values in the OGTT showed the largest area under the receiver operating characteristic curve (AUC) for predicting EarlyIns E\u2010GDM (0.83, 95% confidence interval [CI]: 0.79\u20130.86), followed by the 1\u2009h\u2010PG value (AUC: 0.81, 95% CI: 0.77\u20130.85). The initial increase showed the third largest AUC (0.78, 95% CI: 0.74\u20130.82).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although further research is needed, our data suggest the importance of early insulin therapy in cases of E\u2010GDM with multiple abnormal OGTT values, especially with high 1\u2009h\u2010PG levels and initial increase.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jdi.14318","type":"journal-article","created":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T10:46:09Z","timestamp":1726742769000},"page":"1803-1808","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Multiple positive points during the 75\u2009g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeks"],"prefix":"10.1111","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2395-9591","authenticated-orcid":false,"given":"Yoshifumi","family":"Kasuga","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Keio University School of Medicine  Shinjuku\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Keio University School of Medicine  Shinjuku\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaoru","family":"Kajikawa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Keio University School of Medicine  Shinjuku\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keisuke","family":"Akita","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Keio 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