Comparative Analysis of Health Outcomes in Gestational Diabetes Mellitus: Diet-Controlled Vs. Insulin/Hypoglycemic-Controlled Methods

OBJECTIVES: This study aims to identify potential differences in health outcomes among patients with Gestational Diabetes Mellitus (GDM), focusing on the severity of the condition. GDM, a common pregnancy complication, has a rising global prevalence and is linked to both obstetric complications and the CDC currently states that 50% of women go on to develop type 2 diabetes.

METHODS: We analyzed data from patients diagnosed with GDM within the TriNetX federated network, utilizing de-identified electronic medical records (EMR) from 2013-2023. The study involved two cohorts: a diet-controlled cohort (N=96,678), excluding those on insulin or oral hypoglycemics, and an insulin/hypoglycemic-controlled cohort (N=27,155), excluding diet-controlled cases. Both cohorts were matched on a 1:1 basis using propensity scores to adjust for confounding variables. We assessed the risks of various pregnancy-related complications (e.g., type 2 diabetes, pre-eclampsia, postpartum depression) using risk ratios and conducted a Kaplan-Meier analysis for overall survival. All data definitions adhered to ICD9/10, CPT, and RxNorm standards.

RESULTS: In the matched analysis (N=26,905), the incidence of type 2 diabetes post-GDM was markedly higher in the insulin/hypoglycemic-controlled cohort (18.79%) compared to the diet-controlled cohort (3.97%, RR=0.212). Similar trends were observed for risks of pre-eclampsia (9.18% v. 5.73%, RR=0.624) and cesarean section (28.29% v. 22.19%, RR=0.784), with the insulin/hypoglycemic-controlled cohort showing higher risks. However, no significant differences were noted in overall survival, postpartum depression, hemorrhage, or perineal lacerations between the two groups.

CONCLUSIONS: Patients with GDM managed with insulin or hypoglycemics exhibited higher risks of developing type 2 diabetes, pre-eclampsia, and requiring cesarean sections than those managed by diet alone. Given the results between the two cohorts, it may be beneficial for physicians to have a patient centric focus while presenting options regarding prenatal care and labor and delivery options that are also cost effective and less burdensome.