Follow-up of postpartum women with gestational diabetes mellitus (GDM)

AimThe incidence of type 2 diabetes in postpartum women with gestational diabetes mellitus (GDM) is high, and blood glucose screening for postpartum women is recommended. Follow-up procedures for women with GDM in the postnatal period need to be improved. We investigated the incidence of GDM and the follow-up of women with GDM in Tianjin, China.MethodsPostpartum women who delivered at Tianjin Obstetrics and Gynecology Hospital from January 1st, 2008 to December 31st, 2010 were interviewed by telephone about their blood glucose screening. Thirty obstetricians were interviewed to evaluate awareness about the importance of follow-up.ResultsThe incidence rate of GDM increased from 6.9% in 2008, to 8.8% in 2009, and 9.9% in 2010. A total of 2152 women were interviewed, including 282 women (13.1%) screened for blood glucose. The top three reasons for failed blood glucose screening included: not being informed by their physicians, believing that GDM would disappear after delivery, and being occupied with the baby. Methods for GDM screening included testing of random blood glucose levels, fasting blood glucose levels, oral glucose tolerance, and glycosylated hemoglobin. Of the 30 obstetricians interviewed, 25 were aware of the need for blood glucose screening for women with GDM after delivery, but only 15 of them had informed their patients.ConclusionIn China, most women with GDM are not screened for type 2 diabetes after delivery. Standard clinical procedures that will enable and encourage all women to return for glucose screening following GDM are needed.     

Diabetes screening after gestational diabetes mellitus: poor performance of fasting plasma glucose

Abstract. Gestational diabetes mellitus (GDM) is an established risk factor for the development of overt diabetes. Since the change in diagnostic criteria for diabetes in 1997, it is unclear whether there should be any preference for fasting or post-glucose challenge blood glucose in diagnosing diabetes after GDM. The study aimed at assessing the usefulness of both diagnostic methods in women after GDM. The study enrolled 193 women with previous GDM. Women who did not have a current diagnosis of diabetes were screened for impaired fasting glucose (IFG) and for glucose intolerance with an oral 75-g glucose tolerance test. A total of 45 (23.3%) subjects declared to be already diabetic. Of the 148 non-diabetic subjects, 141 (95.3%) had normal fasting plasma glucose, whereas four (2.8%) had IFG (i.e. FPG6.1 and <7.0 mmol/l) and 3 (2.5%) had FPG7.0 mmol/l. Upon OGTT, among the 141 subjects with normal FPG, 6 (4.3%) were diagnosed with diabetes and 23 (16.3%) with impaired glucose tolerance (IGT); the remaining 112 (79.5%) had normal glucose tolerance. Three out of four subjects with IFG had IGT. The sensitivities of fasting criteria for diagnosis of diabetes and IFG/IGT were 14.3% (95% CI, 8.0%–37.2%) and 17.1% (95% CI, 8.6%–19.8%), respectively. The specificities were 98.6% (95% CI, 97.9%–99.7%) and 99.1% (95% CI, 96.5%–100%), respectively. The kappa for diabetes diagnosis was 0.177 (95% CI, 0.018–0.507). For women with previous GDM, the sensitivity of the new criteria based upon fasting plasma glucose is unacceptably low. In addition, the two sets of criteria are not interchangeable. Therefore, we suggest full glucose tolerance diagnostic procedures in women after GDM, including assessment of post-glucose challenge values.     

Prevalence of type 2 diabetes among women with a previous history of gestational diabetes mellitus

We compared the prevalence of diabetes in women who experienced gestational diabetes mellitus (GDM) with that in the general population and identified risk factors for the development of diabetes.The analysis included 868 subjects (620 GDM and 248 single positive (SP) for one of the diagnostic criteria). The post-partum examinations included 2 h 75 g oral glucose tolerance tests, lipid profiles, anthropometric measurements, and documentation of medical history, diet, and lifestyle. All participants were followed up at 6 weeks after parturition and subsequent follow-ups were conducted annually. General population subjects were identified from the 2001 Korean National Health and Nutrition Survey and age-matched for case–control analysis.Eleven (4.4%) and 71 (11.5%) subjects in the SP and GDM groups, respectively, developed diabetes, while 22 (2.5%) subjects in the general population group presented with diabetes. The risk of developing diabetes was 3.5 times greater for GDM subjects than for general population subjects, after adjusting for confounding factors. A multiple logistic regression model revealed that GDM, a family history of diabetes, and waist circumference were independently associated with the development of diabetes.We concluded that GDM women in Korea are at high risk of diabetes irrespective of the absence of putative risk factors.     

The emerging role of metformin in gestational diabetes mellitus

Metformin use during pregnancy is controversial and there is disparity in the acceptance of metformin treatment in women with gestational diabetes mellitus (GDM) in Australia. Despite short term maternal and neonatal safety measures, the placental transfer of metformin during GDM treatment and the absence of long‐term safety data in offspring has regulators and prescribers cautious about its use. To determine the current role in GDM management, this literature review describes the physiological changes that occur in GDM and other forms of diabetes in pregnancy (DIP) and international changes in guidelines for GDM diagnosis. Management options are considered, with a focus on the evolving evidence for metformin, its mechanism of action, the maternal, foetal and neonatal outcomes associated with its use and benefit vs risk when compared with the current gold standard, insulin. Investigation reveals a favourable balance of evidence to support the safety and long‐term benefits, to mother and child, of using metformin as an alternate to insulin for treatment of GDM. Recent findings of the gastrointestinal‐directed action of metformin are at least as important as the hepatic effect and the availability of a novel delayed‐release metformin dose form to exploit this new information provides a product and therapeutic strategy ideally suited to the use of metformin in GDM.     

Dietary pattern in pregnancy and risk of gestational diabetes mellitus (GDM)

Aim

Among the most common metabolic disorders during pregnancy is gestational diabetes mellitus (GDM). This research was conducted to examine the dietary pattern in women with GDM.

Predictors of postpartum glucose metabolism disorders in women with gestational diabetes mellitus

Background and aimsPostpartum glucose metabolism disorders are a common problem in women with gestational diabetes mellitus (GDM). They are often underdiagnosed since many patients do not attend the postpartum screening. This study aims to assess predictors of postpartum glucose metabolism disorders and type 2 diabetes mellitus (T2DM) after GDM.Material and methodsRetrospective study in women with GMD who underwent postpartum screening for glucose metabolism disorders (n = 2688). Logistic regression was used in the statistical analysis.Results24.6% of women had postpartum glucose metabolism disorder. In multivariate analysis, pre-pregnancy body mass index (BMI) 25–30 kg/m² (OR 1.46, 95%CI 1.05 to 2.02) or BMI ≥30 kg/m² (OR 2.62, 95%CI 1.72 to 3.96), diagnosis of GDM before 20 weeks of pregnancy (OR 2.33, 95%CI 1.57 to 3.46), fasting plasma glucose after diagnosis of GDM ≥90 mg/dl (OR 2.12, 95%CI 1.50 to 2.98), postprandial glucose ≥100 mg/dl (OR 1.47, 95%CI 1.09 to 2.99), and HbA1c in the third trimester of pregnancy ≥5.3% (2.04, 95%CI, 1.52 to 2.75) were independent predictors for any postpartum glucose metabolism disorder.Conclusionpostpartum screening for T2DM should be performed in all women with GDM, and it is especially important not to lose follow-up in those with one or more predictive factors.     

拜糖平和美迪康对2型糖尿病降糖作用的临床疗效比较

比较拜糖平和美迪康对２型糖尿病的临床疗效。方法将单纯饮食控制或加用磺脲类药物治疗不满意的２型糖尿病人８０例，随机分为拜糖平组４８例和美迪康组３２例，疗程为１６周。结果与结论美迪康对降空腹血糖的疗效率主同于拜糖平，耐糖平对降餐后２小时血糖的疗效高于美迪康；     

妊娠糖尿病筛查与诊断的现状

妊娠糖尿病(GDM)在糖尿病的病冈分类中是一个独立的类型.GDM筛杏和诊断的最终目的是改善围产儿预后.高血糖与不良妊娠结局(HAPO)研究提示即使低于GDM诊断标准的高血糖,也与新生儿的出生体重增加及不良孕产结局密切相关.国际上GDM的筛查方法与诊断标准仍未统一,制定全球合理的筛查方法和诊断标准成为国内外学者越来越关注的问题.     

妊娠糖尿病:产后管理减少发生2型糖尿病的风险

妊娠糖尿病(GDM)不仅增加围产期孕妇和胎儿患病的风险,而且增加孕妇产后发生2型糖尿病(T2DM)的风险.GDM发展为T2DM有很多危险因素,关键是重视对GDM妇女产后随访和血糖的筛查,以及产后的各种干预措施如健康的生活方式、母乳喂养和必要时药物干预.这对减少Tr2DM发生的风险有重要意义.     

关注妊娠糖尿病

自1979年世界卫生组织首次将妊娠糖尿病作为糖尿病的一大亚型独立划分出来至今的30．年间,妊娠糖尿病患病率不断增加,其对母婴健康的影响巨大,值得密切关注。妊娠糖尿病的病理机制可能与妊娠期问胰岛素抵抗加剧,以及胰岛素信号转递过程中多个环节受损有关,尚需更多的探索。为了保证母婴健康,对妊娠糖尿病的临床与基础研究仍需进一步加强。     

Fasting plasma glucose to avoid a full OGTT in the diagnosis of gestational diabetes

Aims

To evaluate the performance of fasting plasma glucose (FPG) in determining the need for a full oral glucose tolerance test (OGTT) to diagnose gestational diabetes (GDM) by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria.

Methods

A multicenter cohort study of 4926 pregnant women 20 years or older consecutively enrolled in prenatal care clinics of the Brazilian National Health Service from 1991 to 1995. All women underwent a single 2 h 75 g OGTT by weeks 24–28 of pregnancy and were followed to detect adverse pregnancy outcomes.

Results

A FPG cut-off value of 80 mg/dl indicated that only 38.7% of all women needed to undergo a complete OGTT, while detecting 96.9% of all GDM cases. When the 85 mg/dl cut-off was used, the corresponding percentages were 18.7% and 92.5%, respectively. The fraction of women labeled with GDM who had adverse pregnancy outcomes was nearly identical when using FPG strategies and universal full testing.

Conclusions

Using a FPG cut-off to diagnose GDM and to determine the need for post-load OGTT measurements is a valid strategy to diagnose GDM by IADPSG criteria. This approach may improve feasibility of applying IADPSG diagnostic criteria by reducing costs and increasing convenience.     

妊娠糖尿病发病机制研究进展

妊娠糖尿病(GDM)主要指妊娠期首次发现的糖耐量异常.GDM与非妊娠期的糖尿病都是遗传因素与环境因素共同作用所致的多基因复杂疾病,其发病机制涉及遗传易感性、胰岛素抵抗和分泌缺陷、慢性炎性反应等.而且,GDM病史是女性产后发展为糖尿病的高危因素.因此,深入了解GDM的发病机制具有重要意义.     

妊娠糖尿病的危险因素

妊娠糖尿病是糖尿病分型中的一种独立类型.目前,妊娠糖尿病公认的危险因素包括年龄大于25岁、孕前体重指数大于25 kg/m2、非高加索白人、糖尿病家族史等.近年研究证实,妊娠糖尿病还与其他一些因素相关,如多囊卵巢综合征、身高偏矮、携带HBsAg、高血压等.及早的发现和干预这些高危因素,对于改善孕妇及子代的预后,减少人群中糖尿病的发病率有深远影响.     

Relationships between gut microbiota,plasma glucose and gestational diabetes mellitus

Aims/IntroductionTo investigate the changes in the gut microbiome in the second trimester of pregnancy associated with later‐diagnosed gestational diabetes mellitus (GDM) and their relationship with fasting serum levels of metabolites, especially glucose.Materials and MethodsWe carried out a case–control study with 110 GDM patients and 220 healthy pregnant women who provided fecal samples for 16S ribosomal ribonucleic acid sequencing in the second trimester of pregnancy.ResultsOur results showed that GDM patients had lower α‐diversity that was significantly associated with glycemic traits. Principal coordinates analysis showed significantly different microbial communities, as within GDM patients, seven genera within the phylum Firmicutes and two within the phylum Actinobacteria were significantly decreased, and four genera within phylum Bacteroidetes were increased. In addition, microbiota co‐occurrence network analysis was carried out, and decreased genera within the phylum Firmicutes in GDM patients showed a significant negative correlation with oral glucose tolerance test values. Finally, microbial gene functions related to glycan biosynthesis and metabolism were found to be enriched in GDM patients.ConclusionsOur results show the relationship between changed gut microbiota composition in the second trimester of pregnancy before the diagnosis of GDM and fasting serum levels of metabolites, which might inform the diagnosis, prevention and treatment of GDM.     

妊娠糖尿病的诊断和治疗

妊娠糖尿病(GDM)是指在妊娠期间首次发生或发现的糖尿病。GDM不仅可导致严重母婴并发症,而且增加孕妇产后发生2型糖尿病(T2DM)的风险。GDM发病率逐年增高,不良的妊娠结局与血糖水平相关。了解GDM的诊断标准及治疗原则,以期早诊断、早期治疗GDM,尽可能减少糖尿病的并发症,减少围生期及新生儿多种并发症。     

alpha-Thalassaemia trait and gestational diabetes mellitus in Hong Kong

Aims/hypothesis: The purpose of this study was to examine the association between maternal α-thalassaemia trait and the occurrence of gestational diabetes mellitus in at-risk Chinese women in Hong Kong. Methods: From 3320 pregnant women who had delivered in our hospital and undergone the oral glucose tolerance test for various risk factors over a three-year period, 163 with α-thalassaemia trait were identified (study group). The control group consisted of 163 women chosen from the next patient that was matched for maternal age and parity, following each index case. Comparison was made in the incidence of gestational diabetes mellitus defined by the World Health Organisation criteria, obstetric complications, and perinatal outcome. Results: The incidence of gestational diabetes mellitus was higher in the study group (62.0 % vs 14.7 %, p < 0.0001) which had a higher pre-pregnancy body mass index and lower haemoglobin concentrations. Although more patients in the study group had risk factors (41.7 % vs 26.4 %, p = 0.003), there was no difference in the pregnancy outcome or perinatal complications. Among the gestational diabetic women, those with α-thalassaemia trait were considerably younger and their infants had lower body mass index but there was no significant difference in the outcome. On multiple logistic regression analysis, the α-thalassaemia trait remained an important factor in the diagnosis of gestational diabetes (OR 11.74, 95 % CI 6.37–21.63). Conclusion/interpretation: Among women at risk of gestational diabetes, the presence of the α-thalassaemia trait is an additional risk factor for gestational diabetes mellitus. [Diabetologia (2001) 44: 966–971] Received: 31 October 2000 and in revised form: 5 April 2001     

妊娠糖尿病的药物治疗

妊娠糖尿病是在妊娠过程中首次发现的任何程度的糖耐最异常,其发病机制与多种因素相关.妊娠期间血糖水平对母体、妊娠结局及围产儿的预后有着重要的影响.治疗妊娠糖尿病的药物选择要求能够有效控制血糖,及对胎儿影响小,低血糖事件少,患者依从性好等.目前治疗妊娠糖尿病的药物仍以胰岛素为主,但部分口服降糖药也逐渐进入人们的视野.现就妊娠糖尿病的药物治疗进行概述.