Revisiting maternal adiposity - subcutaneous fat thickness as a robust predictor of insulin requirement in gestational diabetes mellitus.

OBJECTIVES

To prospectively assess the association between pre-gestational (BMI), sonographically measured abdominal subcutaneous fat thickness (ASFT), and the total daily insulin dose required to achieve optimal glycemic control in patients diagnosed with gestational diabetes mellitus (GDM).

MATERIAL AND

METHODS

This prospective, multicenter study included 91 pregnant women with GDM who required insulin therapy, recruited from two tertiary care centers. Demographic data, anthropometric measurements (BMI, ASFT), and laboratory parameters (oral glucose tolerance test [OGTT], HbA1c) were collected. ASFT was measured at the level of the umbilicus using a standardized ultrasound protocol. The relationships between total daily insulin dose, BMI, and ASFT were evaluated using correlation analysis. Statistical analyses were conducted using IBM SPSS Statistics 25.0, with a significance threshold of p < 0.05.

RESULTS

The mean age of the participants was 31.84 ± 6.22 years. The average BMI was 31.81 ± 5.08 kg/m², and the mean ASFT was 19.36 ± 7.77 mm. The mean total daily insulin dose required to maintain glycemic control was 26.20 ± 14.35 units. Correlation analysis demonstrated a statistically significant positive relationship between the total daily insulin dose and both ASFT (r = 0.294, p < 0.01) and BMI. In addition, ASFT was positively correlated with fasting glucose levels on the OGTT (r = 0.329, p < 0.01) and HbA1c values (r = 0.313, p < 0.01).

CONCLUSIONS

Elevated BMI and increased abdominal subcutaneous fat thickness are significantly associated with higher daily insulin requirements in GDM. Abdominal subcutaneous fat thickness, as a non-invasive, readily accessible, and objective ultrasound marker, is a valuable adjunct to BMI for predicting insulin needs in GDM management.