ArticleSAGE open medicine2025
Matsuda index adjusted for sustained hyperglycemia via propensity scores outperforms homeostatic model assessment for insulin resistance in identifying insulin-requiring gestational diabetes mellitus.
Article in SAGE open medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Gestational diabetes mellitus, a glucose metabolism disorder during pregnancy, is linked to insulin resistance. Pregnancy elevates insulin resistance, and gestational diabetes mellitus increases fetal complication risks via excessive glucose transport. Current gestational diabetes mellitus diagnosis relies solely on blood glucose levels, which inadequately guide clinical management or insulin initiation. While homeostatic model assessment for insulin resistance and Matsuda index assess insulin resistance, their utility for insulin treatment evaluation in gestational diabetes mellitus is underexplored. Objectives: Insulin resistance indices with enhanced discriminatory power for gestational diabetes mellitus were evaluated to predict insulin therapy during pregnancy in women suspected of gestational diabetes. Design: This retrospective analysis utilized existing clinical data. Methods: Clinical data from 383 pregnant women with suspected abnormal glucose metabolism at Tenshi Hospital (Jan 2018-Sep 2021) were analyzed. Gestational diabetes mellitus was diagnosed using 75-g oral glucose tolerance test criteria. Evaluations included blood glucose, insulin levels, homeostatic model assessment for insulin resistance, and Matsuda index. The primary outcome was predicting the need for insulin treatment. Statistical analyses involved receiver operating characteristic curves and propensity score adjustment. Results: Body mass index, glycated hemoglobin, glucose/insulin levels, homeostatic model assessment for insulin resistance, quantitative insulin sensitivity check index, and Matsuda index differed between gestational diabetes mellitus and nongestational diabetes mellitus groups. Standalone Matsuda index (area under the curve = 0.714) outperformed homeostatic model assessment for insulin resistance (area under the curve = 0.618) for gestational diabetes mellitus discrimination; however, both exhibited poor model fit. Notably, the propensity score-adjusted composite Matsuda index (Matsuda index × BS Conclusions: The propensity score-adjusted Matsuda index for sustained hyperglycemia (Matsuda index × BS Trial registration: Tenshi Hospital Ethics Committee (approval number: 151; accepted on February 3, 2022).
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