A comparison of meal tolerance test and oral glucose tolerance test for predicting insulin therapy in patients with gestational diabetes

  • Mai Hijikata Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, and Division of Diabetes and Endocrinology, Department of Medicine, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
  • Mariko Higa Division of Diabetes and Endocrinology, Department of Medicine, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
  • Takamasa Ichijo Division of Diabetes and Endocrinology, Department of Medicine, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan https://orcid.org/0000-0002-2969-7396
  • Takahisa Hirose Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan https://orcid.org/0000-0001-6293-5010
Keywords: Gestational diabetes, meal tolerance test, 75g oral glucose tolerance test, insulin resistance, insulin therapy


Aims: To identify factors predicting a need for insulin therapy in gestational diabetes mellitus (GDM) by comparing plasma glucose (PG) levels in a 75-g oral glucose tolerance test (75-g OGTT) with those in a 500-kcal meal tolerance test (MTT) containing 75 g of carbohydrate.

Subjects and methods: The MTT was performed in 61 patients who diagnosed with GDM by a 75-g OGTT (age, 33.2 ± 4.5 years; prepregnancy body mass index, 22.6 ± 4.7 kg/m2; number of gestational weeks, 25.1 ± 6.4 weeks). PG and serum insulin levels were measured before the meal and up to 180 min after the meal. The insulin secretion capacity and resistance index were calculated.

Results: PG levels increased from 86.8 ± 8.8 mg/dL at fasting to 132.7 ± 20.1 mg/dL at 30 min, and 137.8 ± 27.7 mg/dL at 60 min after MTT in the 35 patients with needed insulin therapy; these levels were significantly higher than those in the 26 patients, who only needed diet therapy. The patients with needed insulin therapy had significantly higher fasting PG levels in the 75-g OGTT, PG levels at fasting and 30 min after the MTT, and homeostasis model assessment of insulin resistance (HOMA-IR), and a significantly lower disposition index (DI) and insulin index than patients treated by diet alone. Receiver operating characteristic curve analysis was performed for factors involved in insulin therapy, with the following cutoff values: fasting PG in the 75-g OGTT, 92 mg/dL; PG 30 min after MTT, 129 mg/dL; HOMA-IR, 1.51; DI, 3.9; HbA1c, 5.4%. Multivariate analysis revealed that the 30-min PG level after MTT and HOMA-IR predicted insulin therapy.

Conclusion: PG levels at 30 min after MTT may be useful for identifying patients with GDM, who need insulin therapy.


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  1. International Association of Diabetes and Pregnancy Study groups. International Association of Diabetes and Pregnancy Study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33(3): 676–82.

  2. HAPO study cooperative research group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991–2002.

  3. Coustan DR. Gestational diabetes mellitus. Clinical Chemistry 2013; 59: 1310–21.

  4. Machado C, Monteiro S, Oliveira MJ. Impact of overweight and obesity on pregnancy outcomes in women with gestational diabetes – Results from a retrospective multicenter study. Arch Endocrinol Metab 2020; 64(1): 45–51.

  5. Alves JG, Souza ASR, Figueiroa JN, Araūjo CAL, Guimaraes A, Ray JG. Visceral adipose tissue depth in early pregnancy and gestational diabetes mellitus – A cohort study. Sci Rep 2020; 10: 2032.

  6. Sun YY, Juan J, Xu QQ, Su RN, Hirst JE, Yang, H-X. Increasing insulin resistance predicts adverse pregnancy outcomes in women with gestational diabetes mellitus. J Diabetes 2020; 12(6): 1–9.

  7. Bellamy L, Casas J-P, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373: 1773–9.

  8. Nadal A, Alonso-Magdalena P, Soriano S, Ropero AB, Quesada I. The role of oestrogens in the adaptation of islets to insulin resistance. J Physiol 2009; 587(21): 5031–7.

  9. Barbour LA. Metabolic culprits in obese pregnancies and gestational diabetes mellitus: big babies, big twists, big picture. Diabetes Care 2019; 42: 718–26.

  10. Buchanan TA. Pancreatic b-cell defects in gestational diabetes: implications for the pathogenesis and prevention of type 2 diabetes. J Clin Endocrinol Metab 2001; 86(3): 989–993.

  11. Papachatzopoulou E, Chatzakis C, Lambrinoudaki I, Panoulis K, Dinas K, et al. Abnormal fasting, post-load or combined glucose values on oral glucose tolerance test and pregnancy outcomes in women with gestational diabetes mellitus. Diabetes Res Clin Pract 2020; 161: 108048.

  12. Matsda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with euglycemic insulin clamp. Diabetes Care 1999; 22(9): 1462–70.

  13. Henríquez S, Jara N, Bunout D, Maza SHMP, Leiva L, Barrera G. Variability of formulas to assess insulin sensitivity and their association with the Matsuda index. Nutr Hosp 2013; 28(5): 1594–8.

  14. Yokota K, Fukushima M, Takahashi Y, Igaki N, Seino S. Insulin secretion and computed tomography values of pancreas in the early stage of the development of diabetes. J Diab Invest 2012; 3(4): 371–6.

  15. Wilkins PA, Sheahan BJ, Vader Werf KA, Castagnetti C, Hardy J, Schoster A, et al. Preliminary investigation of the area under the L-lactate concentration-time curve (LAC AREA) in critically Ill equine neonates. J Vet Intern Med 2015; 29: 659–662.

  16. Ikenoue S, Miyakoshi K, Saisho Y, Sakai K, Kasuga K, Fukutake M, et al. Clinical impact of women with gestational diabetes mellitus by the new consensus criteria: two year experience in a single institution in Japan. Endocr J 2014; 61(4): 353–8.

  17. Sugiyama T, Metoki H, Hamada H, Nishigori H, Saito M, et al. A retrospective multi-institutional study of treatment for mild gestational diabetes in Japan. Diabetes Res Clin Pract 2014; 103(3): 412–18.

  18. Nishikawa T, Ono K, Hashimoto S, Kinoshita H, Watanabe T, Araki H, et al. One-hour oral glucose tolerance test plasma glucose at gestational diabetes diagnosis is a common predictor of the need for insulin therapy in pregnancy and postpartum impaired glucose tolerance. J Diabetes Invest 2018; 9: 1370–7.

  19. Marais C, Hall DR, Wyk LV, Conradie M. Randomized cross-over trial comparing the diagnosis of gestational diabetes by oral glucose tolerance test and a designed breakfast glucose profile. Inter J Gynecol Obstet 2011; 141(1): 85–90.

  20. Cheney C, Shiragg P, Hollingsworth D. Demonstration of heterogeneity in gestational diabetes by a 400-kcal breakfast meal tolerance test. Obstet Gynecol 1985; 65(1): 17–23.

  21. Hao M, Lin L. Fasting plasma glucose and body mass index during the first trimester of pregnancy as predictors of gestational diabetes mellitus in a Chinese population. Endocr J 2017; 64(5): 561–9.

  22. Jokelainen M, Lempinen BS, Rȍnȍ K, Nenonen A, Kautiainen H, et al. Oral glucose tolerance test results in early pregnancy: a Finnish population-based cohort study. Diabetes Res Clin Pract 2020; 162: 108077.

  23. Sharma K, Wahi P, Gupta A, Jandial K, Bhagat R, et al. Single glucose challenge test procedure for diagnosis of gestational diabetes mellitus: a Jammu cohort study. J Assoc Physicians India 2013; 61(8): 558–9.

  24. Tang L, Xu S, Li P, Li L. Predictors of insulin treatment during pregnancy and abnormal postpartum glucose metabolism in patients with gestational diabetes mellitus. Diabetes Metb Syndr Obes 2019; 12: 2655–65.

  25. Catalano PM, Tyzbir ED, Roman NM, Amini SB, Sims EA. Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women. Am J Obstet Gynecol 1991; 165: 1667–72.

  26. Wang L, Hao JM, Yu AQ, Li TT, Liu RR, Li J, et al. The association of plasma peroxiredoxin 3 with insulin in pregnant women. Biochem Biophys Res Commun 2019; 508(3): 805–10.

  27. Moyce BL, Doinsky VW. Maternal β-cell adaptations in pregnancy and placental signalling: implication for gestational diabetes. Int J Mol Sci 2018; 19: 3467.

  28. Sorenson RL, Brelje TC. Adaptation of islets of Langerhans to pregnancy: beta-cell growth, enhanced insulin secretion and the role of lactogenic hormones. Horm Metab Res 1997; 29(6): 301–7.

  29. Yang W, Jiang Y, Wang Y, Zhang T, Liu Q, Wang C, et al. Placental growth factor in beta cells plays an essential role in gestational beta-cell growth. BMJ Open Diab Res Care 2020; 8: e000921.

  30. Sunehag AL, Man CD, Toffolo G, Haymond MW, Bier DM, Cobelli C. β-Cell function and insulin sensitivity in adolescents from an OGTT. Obesity 2008; 17: 233–9.

  31. Bergman RN, Ader M, Bergman, HueckingK , CittersGV . Accurate assessment of β-cell function: the hyperbolic correction. Diabetes 2002; 51: 212–20.

  32. Retnakaran R, Shen S, Hanley AJ, Vuksan V, Hamilton JK, Zinman B. Hyperbolic relationship between insulin secretion and sensitivity on oral glucose tolerance test. Obesity 2008; 16: 1901–7.

  33. Standards of Medical Care in Diabetes-2020. Management of diabetes in pregnancy. Diabetes Care 2020; 43(1)

  34. Nigam A, Sharma S, Varun N, Munjal YP, Prakash A. Comparative analysis of 2-week glycemic profile of healthy versus mild gestational diabetic pregnant women using flash glucose monitoring system: an observational study. BJOG 2019; 126(4): 27–33.

  35. Mustad VA, Huynh DTT, Lōpez-Pedrosa JM, Campoy C, Rueda R. The role of dietary carbohydrates in gestational diabetes. Nutrients 2020; 12(2): 385.

  36. Chivese T, Norris SA, Levitt NS. High prevalence of cardiovascular risk factors and insulin resistance 6 years after hyperglycemia first detected in pregnancy in Cape Town, South Africa. BMJ Open Diabetes Res Care 2019; 7(1): e000740.

  37. Lowe W Jr., Shltens M, Loe LP, Kuang A, Nodzenski M, Talbot O, et al. Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity. JAMA 2018; 20(10): 1005–16.

How to Cite
Hijikata M., Higa M., Ichijo T., & Hirose T. (2021). A comparison of meal tolerance test and oral glucose tolerance test for predicting insulin therapy in patients with gestational diabetes. Food & Nutrition Research, 65. https://doi.org/10.29219/fnr.v65.5490
Original Articles