{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T22:59:10Z","timestamp":1773269950557,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Objectives: We aimed to develop and validate a simple, easy-to-use risk stratification tool to use in the diagnosis of gestational diabetes mellitus (GDM) to triage those more likely to require insulin treatment. Methods: Using an audit of patients with GDM in 2019, multivariable logistic regression was used to select variables and develop a prediction model for insulin requirement. A stratification tool was developed by dichotomising these selected variables; its performance was assessed with an internal cohort from 2021 and externally from patients managed at a separate hospital. Results: Patients with a higher fasting blood glucose concentration (OR 2.41, 95% CI 1.84\u20133.15) and higher booking body mass index (OR 1.48, 95% CI 1.07\u20132.03) were more likely to require insulin therapy whilst a later gestational-weeks-at-diagnosis value gave a lower risk of insulin therapy (OR 0.71, 95% CI 0.62\u20130.81 per week). The low-risk group for insulin requirement was defined thus: fasting blood glucose &lt; 5.6 mmol\/L, booking BMI &lt; 30 kg\/m2, and gestational weeks at diagnosis \u2265 24 weeks. This classification had a negative predictive value (NPV) of 94% for insulin requirement, with a sensitivity of 84% and specificity of 56% in the development cohort. Similarly, in the internal and external validation cohorts, the NPVs were 93 and 90%, with sensitivity values of 77 and 78%, respectively. Conclusions: This study developed a pragmatic tool with three criteria for stratifying the GDM group not requiring insulin treatment, with successful validation for clinical use.<\/jats:p>","DOI":"10.3390\/jpm15060223","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T04:27:58Z","timestamp":1748579278000},"page":"223","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Developing a Risk Stratification Tool to Predict Patients with Gestational Diabetes Mellitus at Risk of Insulin Treatment: A Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5823-1985","authenticated-orcid":false,"given":"Xi","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Women and Children\u2019s Heath, King\u2019s College London, London SE1 7EH, UK"},{"name":"Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0NN, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah L.","family":"Nathan","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Division of Women\u2019s Health, Princess Royal University Hospital, Kings College Hospital NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ebruba E.","family":"Oyekan","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Division of Women\u2019s Health, Princess Royal University Hospital, Kings College Hospital NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7961-8791","authenticated-orcid":false,"given":"Tim I. M.","family":"Korevaar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doaa","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Women\u2019s Services, Guys\u2019 and St Thomas\u2019 NHS Foundation Trust, London SE1 9RT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Pacifico","sequence":"additional","affiliation":[{"name":"Women\u2019s Services, Guys\u2019 and St Thomas\u2019 NHS Foundation Trust, London SE1 9RT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aisha","family":"Hameed","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Division of Women\u2019s Health, Princess Royal University Hospital, Kings College Hospital NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8024-6339","authenticated-orcid":false,"given":"Manju","family":"Chandiramani","sequence":"additional","affiliation":[{"name":"Department of Women and Children\u2019s Heath, King\u2019s College London, London SE1 7EH, UK"},{"name":"Women\u2019s Services, Guys\u2019 and St Thomas\u2019 NHS Foundation Trust, London SE1 9RT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9442-9662","authenticated-orcid":false,"given":"Anita","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Department of Women and Children\u2019s Heath, King\u2019s College London, London SE1 7EH, UK"},{"name":"Women\u2019s Services, Guys\u2019 and St Thomas\u2019 NHS Foundation Trust, London SE1 9RT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4859-0324","authenticated-orcid":false,"given":"Caroline","family":"Ovadia","sequence":"additional","affiliation":[{"name":"Department of Women and Children\u2019s Heath, King\u2019s College London, London SE1 7EH, UK"},{"name":"Women\u2019s Services, Guys\u2019 and St Thomas\u2019 NHS Foundation Trust, London SE1 9RT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1007\/s13224-023-01893-2","article-title":"Gestational Diabetes and Analysis of Maternal and Fetal Outcomes Among Pregnant Women: A Cross-Sectional Study","volume":"74","author":"Biju","year":"2023","journal-title":"J. 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