血糖控制对妊娠期糖尿病患者妊娠结局的影响

目的探讨血糖控制对妊娠期糖尿病患者妊娠结局的影响。方法对104例妊娠期糖尿病（GDM）患者给予糖尿病规范化治疗,依据血糖控制情况分为观察组73例和对照组31例。比较两组治疗后的妊娠并发症发生率和围生儿结局情况。结果观察组妊高症、羊水过多和巨大儿、早产儿、新生儿窒息发生率明显降低,与对照组比较,差异具有显著性（P〈0．05）;而孕妇感染、产后出血、剖宫产及胎儿窘迫、新生儿低血糖发生率组间比较无显著性差异（P〉0．05）。结论良好的血糖控制对GDM患者妊娠结局有着积极有利的影响,应重视GDM的早期治疗和血糖的定期检测。     

Gestational diabetes mellitus screening tests: a review of current recommendations.

Early recognition and management of gestational diabetes decreases the incidence of macrosomia. Infant morbidity and mortality are also decreased. While there continues to be little agreement regarding precise methods of screening and diagnostic criteria for GDM, most specialists recommend screening with the 50-g oral glucose load followed by a 3-hour GTT. Screening only those women with select risk factors may result in 30% to 50% of women with gestational diabetes being overlooked. Careful explanation of testing methods and implications may result in improved patient understanding of the importance of this diagnosis and of its impact on future health care needs.     

Gestational diabetes mellitus

In summary, much controversy exists surrounding the diagnosis, treatment, and even existence of GDM. At present, there is not enough evidence to advocate the Carpenter and Coustan criteria over the NDDG criteria. In univariate analysis, the Toronto Tri-Hospital Study demonstrated an increased incidence of cesarean section, macrosomia, and preeclampsia with increasing carbohydrate intolerance in those who did not meet NDDG criteria for GDM. Multivariate analysis, however, showed that this contribution is small relative to other nonmodifiable risk factors. A shift to the Carpenter and Coustan criteria would identify a larger population of patients with GDM and increase treatment costs. In addition, although treatment of these borderline GDM patients might reduce macrosomia, there is no evidence to indicate that it reduces the cesarean section rate. The precise threshold at which glucose intolerance adversely affects pregnancy outcomes and increases the risk for the development of type 2 diabetes in the mother is unknown. The perinatal risks associated with hyperglycemia seem to increase continuously with increasing maternal hyperglycemia. More randomized intervention trials are needed to define the effects of graded increases in glucose intolerance on maternal and fetal morbidity.     

妊娠期糖尿病对新生儿早期并发症及血脂水平的影响

目的探究妊娠期糖尿病对新生儿早期并发症发生情况及血脂水平的影响。方法随机抽取2016年10月至2018年10月我院90例健康孕妇(对照组)及90例妊娠期糖尿病患者(试验组)为观察对象,比较两组新生儿并发症发生率及血脂水平。同时,结合90例妊娠期糖尿病患者血糖控制情况将其分为血糖控制满意组(61例)和血糖控制不满意组(29例),对比两组新生儿并发症发生率及血脂水平。结果试验组巨大儿、新生儿感染、窒息、低血糖、高胆红素症及呼吸窘迫综合征发生率均高于对照组(P<0.05)。试验组新生儿TC、TG、LDL-C水平均高于对照组,HDL-C水平低于对照组(P<0.05)。血糖控制满意组巨大儿、新生儿感染、低血糖及高胆红素症发生率均显著低于血糖控制不满意组(P<0.05),但两组新生儿窒息、呼吸窘迫综合征发生率无显著差异(P>0.05)。血糖控制满意组新生儿TG、LDL-C水平明显低于血糖控制不满意组(P<0.05),但两组TC、HDL-C水平比较无显著差异(P>0.05)。结论妊娠期糖尿病是导致巨大儿、新生儿感染、低血糖、高胆红素症、窒息、呼吸窘迫综合征等并发症以及血脂水平升高的高危因素,而孕期血糖控制效果良好有助于降低新生儿并发症发生率及血脂水平,保障母婴安全。     

Prepregnancy care and pregnancy outcomes in women with type 1 diabetes

OBJECTIVE: The objective of this study was to examine the relationship between prepregnancy care, glycemic control, maternal hypoglycemia, and pregnancy outcomes in women with type 1 diabetes. RESEARCH DESIGN AND METHODS: This was a prospective observational cohort study of women with type 1 diabetes who delivered from 1991 to 2002. Outcome measures were attendance at a clinic for prepregnancy care, maternal HbA(1c) (A1C) throughout pregnancy, maternal severe hypoglycemic episodes, macrosomia, preeclampsia, premature delivery (delivery before 37 weeks), very premature delivery (delivery before 34 weeks), spontaneous abortion, and adverse pregnancy outcome (defined as major malformation, stillbirth, and neonatal death). RESULTS: There were 290 pregnancies, in which 110 (38%) women had prepregnancy care. The prepregnancy care group contained more primiparous women (54.7 vs. 40.6%; P = 0.021) and fewer smokers (9.4 vs. 28.7%; P < 0.0001). They registered earlier (6.6 vs. 8.3 weeks, P < 0.0001) and had a lower A1C at the initial visit (6.5% vs. 7.6%; P < 0.0001). Adverse pregnancy outcomes and very premature deliveries were significantly lower in women who received prepregnancy care (2.9 vs. 10.2%; P = 0.03 and 5.0 vs. 14.2%; P = 0.02, respectively). In contrast, between groups, there was no difference in A1C after 24 weeks or in the rates of macrosomia, preeclampsia, or maternal severe hypoglycemic episodes. CONCLUSIONS: Prepregnancy care was associated with improved glycemic control in early pregnancy and significant reductions in adverse pregnancy outcome (malformation, stillbirth, and neonatal death) and very premature delivery. However, prepregnancy care failed to have an impact on glycemic control in later pregnancy or to reduce the risk of macrosomia and preeclampsia.     

妊娠期糖尿病孕妇血糖控制与护理干预

目的:探讨糖尿病护理干预和胰岛素泵使用对妊娠期糖尿病孕妇巨大儿出生率的影响。方法:将200例妊娠期糖尿病患者随机分为干预组和对照组各100例,干预组采用针对性护理干预,包括糖尿病疾病保健、心理护理、饮食控制、药物治疗、适当运动、自我管理及胰岛素泵治疗等;对照组采用常规护理。比较干预组护理干预前后(2个月)血糖指标及两组巨大儿出生率情况。结果:2个月后干预组孕妇血糖指标明显降低,巨大儿出生率比对照组明显减少,差异有统计学意义(P<0.05)。结论:有效的糖尿病护理干预能有效控制妊娠糖尿病患者血糖,并降低其巨大儿出生率。     

妊娠期糖尿病合理处理与妊娠结局关系

目的 探讨妊娠期糖尿病(GDM)对妊娠结局和新生儿结局的影响.方法 对42例GDM患者(GDM组)和120例正常妊娠孕妇(对照组)的临床资料进行回顾性分析,对2组的妊娠结局、妊娠并发症及新生儿结局进行比较.结果 对照组、GDM组剖宫产率分别为60.0%、93.5%,有手术指征者分别占18.3%、51.6%,早产率分别为9.2%、22.6%,巨大儿发生率分别为6.7%、19.4%,GDM组均明显高于对照组(P<0.05).结论 GDM孕妇的手术产率、早产率及巨大儿发生率均明显升高,应密切关注GDM孕妇,早期筛查,早期处理,以减少母婴并发症的发生.     

妊娠期糖尿病合理处理与妊娠结局关系

目的 探讨妊娠期糖尿病(GDM)对妊娠结局和新生儿结局的影响.方法 对42例GDM患者(GDM组)和120例正常妊娠孕妇(对照组)的临床资料进行回顾性分析,对2组的妊娠结局、妊娠并发症及新生儿结局进行比较.结果 对照组、GDM组剖宫产率分别为60.0%、93.5%,有手术指征者分别占18.3%、51.6%,早产率分别为9.2%、22.6%,巨大儿发生率分别为6.7%、19.4%,GDM组均明显高于对照组(P<0.05).结论 GDM孕妇的手术产率、早产率及巨大儿发生率均明显升高,应密切关注GDM孕妇,早期筛查,早期处理,以减少母婴并发症的发生.     

妊娠期糖尿病合理处理与妊娠结局关系

目的探讨妊娠期糖尿病（GDM）对妊娠结局和新生儿结局的影响。方法对42例GDM患者（GDM组）和120例正常妊娠孕妇（对照组）的临床资料进行回顾性分析,对2组的妊娠结局、妊娠并发症及新生儿结局进行比较。结果对照组、GDM组剖宫产率分别为60．0％、93．5％,有手术指征者分别占18．3％、51．6％,早产率分别为9．2％、22．6％,巨大儿发生率分别为6．7％、19．4％,GDM组均明显高于对照组（P〈0．05）。结论GDM孕妇的手术产率、早产率及巨大儿发生率均明显升高,应密切关注GDM孕妇,早期筛查,早期处理,以减少母婴并发症的发生。     

Nurse-based management in patients with gestational diabetes

OBJECTIVE: To compare the rate of insulin treatment and perinatal outcome in women with gestational diabetes mellitus (GDM) under endocrinologist-based versus diabetes nurse-based metabolic management. RESEARCH DESIGN AND METHODS: In a retrospective analysis, maternal characteristics, rate of insulin treatment, and perinatal outcome of patients with GDM delivering between 1 January 1995 and 30 June 1997 (n = 244) receiving endocrinologist-based care were compared with those delivering between 1 July 1997 and 31 December 1999 (n = 283) who received diabetes nurse-based care. The diabetes nurse's role was similar to that of an advanced practice nurse in the U.S. There were no changes in the metabolic goals and instruments or in obstetric and neonatal management. Quantitative data were compared with the Mann-Whitney U test and categorical data, with Fisher's exact test. RESULTS: Maternal characteristics (age, BMI, family history of diabetes, prior glucose intolerance, gestational age, and blood glucose at diagnosis of GDM) did not differ between groups treated during the two periods. Rates of insulin treatment and perinatal outcome (hypertension, preterm delivery, cesarean section, low Apgar score, macrosomia, small- and large-for-gestational-age newborns, obstetric trauma, major malformations, hypoglycemia, hypocalcemia, polycythemia, jaundice, respiratory distress, and mortality) were also similar in both groups. CONCLUSIONS: Comparison of periods of endocrinologist-based and diabetes nurse-based metabolic management of women with GDM showed no differences in the rate of insulin treatment and perinatal outcome. This supports a more active role of nurses in the management of women with GDM.     

Pre-conception care and support for women with diabetes

This article discusses the National Service Framework for Diabetes: Standards (Department of Health, 2001), with the main focus on Standard 9: diabetes and pregnancy. It concentrates on pre-conception care and support for women with pre-existing diabetes to optimize the outcome of their pregnancy. The rationale for this is the need to understand how this standard affects women with diabetes during childbearing age. Following an introduction to aetiology and epidemiology of diabetes, the author examines the importance of pre-conception care for women with diabetes. An acknowledgement of the deficits within the clinical environment aids recommendations on improvement of education and knowledge for nurses. Health promotion and patient support is emphasized to facilitate an understanding of the impact of diabetes on pregnancy and the necessity of the multidisciplinary team involvement before, during and after birth.     

The impact of financial incentives on utilization and outcomes of diabetes prevention programs among Medicaid managed care adults in New York state

Diabetes prevalence has risen rapidly and has become a global health challenge. The Diabetes Prevention Program (DPP) has been shown to prevent or delay the development of diabetes among individuals with prediabetes. Yet, diabetes prevention studies within the Medicaid population are limited and results are mixed. This study aimed to evaluate the impact of different financial incentive strategies on the utilization of the DPP for Medicaid managed care adults in New York State.A four-arm randomized controlled trial was conducted among Medicaid managed care adult enrollees diagnosed with prediabetes and/or obesity. Study participants were offered a 16-week DPP with various incentive strategies based on class attendance and weight loss as follows: Attendance-Only, Weight-Loss Only, and both Attendance and Weight-Loss. A control group was offered DPP with no incentives for attendance or weight loss. We evaluated the impact of incentives on achievement of the program completion and weight-loss milestone.Participants who received incentives for the Attendance-Only class were least likely to be lost to follow-up, more likely to complete the program, and had two times higher percentage of meeting the weight-loss milestone compared to the control group. Results for the other incentive cohorts were mixed. A strong positive association was observed for participants who attended 9 or more classes and weight-loss regardless of incentive strategies.Providing monetary incentives for DPP class attendance had a positive impact on program completion and achieving the weight-loss milestone. However, the results from this study indicate that participant enrollment and retention remained challenges despite the incentives.     

Effect of individualized medical nutrition guidance on pregnancy outcomes in older pregnant women

ObjectiveWe aimed to explore the effect of individualized medical nutrition guidance on pregnancy outcomes among older pregnant women.MethodsThis was a prospective study using a randomized controlled trial design. We selected 820 older pregnant women and randomly divided them into a study group and control group (410 women each). The control group was given routine health education and nutrition guidance; the study group was provided individualized medical nutrition guidance. Gestational diabetes mellitus, hypertensive disorders of pregnancy, vaginal delivery rate, postpartum hemorrhage rate, gestational body weight, neonatal birth weight, and neonate transfer to the neonatal intensive care unit (NICU) were compared between the groups.ResultsThe incidence of gestational diabetes in the study group was significantly lower and the rate of vaginal delivery was significantly higher than those in the control group. The incidence of macrosomia, rate of neonatal transfer to the NICU, and rate of neonatal hyperbilirubinemia were significantly lower in the study group than those in the control group.ConclusionsIndividualized nutritional intervention for older pregnant women can effectively reduce the incidence of complications during pregnancy and childbirth and improve maternal and child outcomes.     

New insulin analogues and their impact on diabetes care

The rising incidence of diabetes means that it is no longer viable for patients to be treated solely within the secondary care setting and primary health-care professionals, including community nurses working within community-based diabetes clinics, are likely to continue to take on greater responsibility for the assessment and management of patients with diabetes. This article discusses recent advances in insulin therapy--namely the advent of the new insulin analogues--and examines their likely impact on community nurses in terms of improved time management and quality of care for patients with diabetes on patients in terms of improved quality of care.     

药学服务在妊娠期糖尿病治疗中的临床效果

目的:探究药学服务在妊娠期糖尿病治疗中的临床效果.方法:选择2018年1月至2019年10月康平县人民医院收治的82例妊娠期糖尿病患者为研究对象,依据随机数字表法,将研究对象分为两组,对照组和研究组(每组41例),对照组给予传统医疗服务干预,研究组在前者基础上开展药学服务,比较两组患者的血糖控制满意情况和母婴结局.结果...     

Teenagers with diabetes: self-management education and training on a big schooner

The aims of this study are to evaluate whether diabetic teenagers participating in a group educational programme, 'the schooner programme', differ from non-participants in attitudes towards diabetes and self-care, and to evaluate the impact on the attitudes, HbA1c and treatment of the programme. Ninety teenagers aged 14-18 years attended the programme. Attitudes towards diabetes and self-care were measured with a validated questionnaire. Medical data were collected from the medical records. The participants reported more positive attitudes towards diabetes and self-care and more frequent contacts with others with diabetes monitored blood glucose more often and felt less disturbed by diabetes than non-participants. The programme had positive impact on attitudes towards diabetes. There was no change in HbA1c, but the use of insulin pumps was more frequent among participants after the programme. To get teenagers attracted to group education, the diabetes care team needs to influence them towards more positive attitudes.     

C-reactive protein,diabetes, and attendance at religious services

OBJECTIVE: Previous studies have shown an association between attendance at religious services and health, particularly cardiovascular morbidity and mortality. People with diabetes have higher risk of cardiovascular mortality and higher C-reactive protein (CRP) levels than people without diabetes. The purpose of this study was to explore the relationship between religious attendance and CRP in people with diabetes. RESEARCH DESIGN AND METHODS: This study used cross-sectional survey and examination of a nationally representative sample of noninstitutionalized U.S. adults aged > or = 40 years, derived from the National Health and Nutrition Examination Survey III 1988-1994 (n = 10,059). There were 556 people with diabetes. The primary outcome measure was the presence of elevated CRP. RESULTS: There were no differences between people with diabetes compared with people without diabetes in the percentage of those who attended religious services (62.29 vs. 62.0%, P = 0.36). Religious service nonattenders with diabetes were more likely than attenders to have an elevated CRP (odds ratio [OR] 2.17 [95% CI 1.15-4.09]). In people without diabetes, the association between attendance and CRP was not significant (P > 0.05). Among people with diabetes, after adjusting for demographic variables, health status, smoking, social support, mobility, and BMI, the association between religious attendance and CRP remained significant for respondents with diabetes (1.90 [1.03-3.51]). CONCLUSIONS: These findings revealed that people with diabetes who have not attended religious services in the previous year are more likely to have elevated levels of CRP. Further research should be conducted to evaluate this association to improve our understanding of the psychological and religious factors that influence diabetes.     

Lipid testing among patients with diabetes who receive diabetes care from primary care physicians

OBJECTIVE: To identify factors related to lipid testing among patients with diabetes who receive diabetes care from primary care physicians. RESEARCH DESIGN AND METHODS: North Carolina Medicare claims were used to identify individuals with diabetes who received diabetes care from primary care physicians. Lipid testing was related to sociodemographic characteristics, comorbid conditions, physician specialty, and mortality. RESULTS: Based on Medicare claims from July 1997 through June 1999, 13,660 diabetic North Carolina residents with Medicare, 65-75 years of age, had received HbA(1c) testing from a single primary care physician during at least three of four consecutive 6-month time intervals. During these 2 years, 31% had no lipid profile and 24% had only one lipid profile. Caucasians were 1.6 times more likely than African Americans to receive lipid profiles. Patients not receiving state Medicare assistance were 1.4 times more likely to have a lipid profile than the presumably lower-income patients receiving assistance. Patients with stroke and heart failure were less likely to receive lipid profiles. Those with no lipid profile were almost twice as likely to die from cardiovascular disease than those with at least two lipid profiles. CONCLUSIONS: Adherence to lipid testing recommendations by primary care physicians for elderly patients with diabetes has much room for improvement. The most vulnerable patients (African Americans, the economically disadvantaged, and the medically complex) are the least likely to receive lipid testing.     

An economic analysis of interventions for diabetes

The objective of this article is to stratify interventions for diabetes according to their economic impact. We conducted a review of the literature to select articles that performed a cost-benefit analysis for 17 widely practiced interventions for diabetes. A scale for categorizing interventions according to their economic impact was defined. The 17 interventions were classified as follows: 1) clearly cost-saving, 2) clearly cost-effective, 3) possibly cost-effective, 4) non-cost-effective, or 5) unclear. Clearly cost-saving interventions included eye care and pre-conception care. Clearly cost-effective interventions included nephropathy prevention in type 1 diabetes and improved glycemic control. Possibly cost-effective interventions included nephropathy prevention in type 2 diabetes and self-management training. Non-cost-effective interventions were not identified. Interventions with unclear economic impact included case management, medical nutrition therapy, self-monitoring of blood glucose, foot care, blood pressure control, blood lipid control, smoking cessation, exercise, weight loss, HbA1c measurement, influenza vaccination, and pneumococcus vaccination. Widely practiced interventions for patients with diabetes can be clearly cost-saving and clearly cost-effective. These practices are attractive from both a medical and an economic perspective.     

Does systematically organized care improve outcomes for women with diabetes?

Objective To investigate whether financial reimbursement for a bundle of diabetes care items self‐reported by general practitioners (GPs) leads to improved outcomes for women with diabetes. Methods Longitudinal cohort study of women in the Australian Longitudinal Study on Women's Health aged 45–50 and 70–75 years when recruited in 1996. Outcomes Short Form 36‐item (SF‐36), Medicare and pharmaceutical benefits costs 2002–2005, uptake of annual cycle of care for diabetes (ACC). Results Annual cycle of care claims were identified for 23% of 388 mid‐age, and 40% of 616 older women with diabetes. ACC was not associated with statistically significantly higher costs in either group. Women for whom the GP had received an ACC fee were more likely to have been overweight, had more GP visits, more medications, and more ‘no cost’ visits. Unlike older women, mid‐age women for whom the GP had received an ACC fee were more likely to have difficulty managing on their income and tended to have worse physical and social function scores prior to the time the ACC was introduced and compared with other women with diabetes continued to have poorer scores at subsequent surveys. There was no association between ACC, co‐morbidities or country of birth. Women who developed diabetes after the first survey (incident cases) tended to have better SF‐36 health profile scores and lower costs than those who reported diabetes on the first survey (prevalent cases). Conclusions General practitioners of women with diabetes, who have more health care encounters and poorer health‐related quality of life, have adopted ACC with little impact on the decline in quality of life of the women nor on health care costs.