孕期血糖监测的方法及应用

妊娠期糖尿病不仅增加母儿围生期风险,还可导致远期代谢紊乱的发生。对妊娠期糖尿病患者实施严格的血糖控制非常必要。临床常见的血糖监测方法包括自我血糖监测,适合于已诊断为糖尿病(妊娠期糖尿病、1型或2型糖尿病)的孕妇;动态血糖监测,针对糖尿病合并妊娠,需胰岛素治疗的孕妇出现血糖波动大、无法解释的异常血糖等情况;糖化血红蛋白和糖化血清蛋白,反映一段时间内平均血糖水平。本文对以上血糖监测方法分别进行综述。     

餐后血糖与妊娠期糖尿病胎儿发育研究进展

妊娠期糖尿病(GDM)系指妊娠期间首次发生或识别的糖耐量异常.GDM患者高血糖对妊娠妇女、胎儿和新生儿的负性影响将引起严重的母婴并发症.餐后血糖增高是GDM血糖控制差的重要表现,也是GDM代谢紊乱的最早期表现.研究发现控制餐后血糖尤其是餐后1h血糖水平可以有效改善妊娠结局,降低剖宫产率,减少巨大儿、大于胎龄儿及畸形儿的发病率,减少产伤.故GDM患者妊娠期监测餐后1h血糖水平可以用于指导饮食控制和胰岛素治疗剂量的调整.     

糖化血红蛋白在围生期的运用

糖化血红蛋白(HbA1c)作为诊断糖尿病,监测血糖控制的有效指标已被临床广泛接受,满意的血糖控制是糖尿病合并妊娠以及妊娠期糖尿病获得良好妊娠结局的关键。对HbA1c与糖尿病合并妊娠、妊娠期糖尿病、产后糖耐量异常、糖尿病并发症等的关系进行综述,认为HbA1c控制不满意孕妇发生流产、子痫前期、产后糖耐量异常等可能性增加,同时发生胎儿先天畸形、巨大儿以及围生儿死亡的可能性也增加。HbA1c可作为妊娠期监测血糖的补充手段,但目前妊娠期HbA1c参考值尚未达成共识,因此,广泛使用HbA1c作为妊娠期糖尿病和糖尿病合并妊娠的诊断和治疗效果评价指标的前提条件之一是HbA1c的检测标准化和阈值的标准化。     

妊娠期糖尿病与妊娠期高血压疾病相关性的研究进展

妊娠期糖尿病与妊娠期高血压疾病是妊娠期特有且常见的疾病,对母婴都能产生不良影响。研究表明,妊娠期糖尿病患者并发妊娠期高血压疾病的危险性明显升高,这可能与胰岛素抵抗、高血糖、肥胖等因素密切相关。及早进行妊娠期糖尿病、妊娠期糖耐量异常的诊断,严密监测妊娠期血糖、血压,控制饮食,适量运动,可降低妊娠期糖尿病患者妊娠期高血压疾病的发生率。     

综合护理干预对妊娠期糖尿病患者血糖水平的影响

目的:探讨护理干预对妊娠期糖尿病患者血糖水平的影响。方法:选择2009年1月至2010年6月我科收治的35例妊娠期糖尿病患者,进行生理、心理、家属等综合干预。结果干预后患者的血糖水平比干预前明显好转。结论:综合护理干预能提高GDM患者对疾病的认识程度,调整生活习惯,自觉采取措施控制血糖,定期产前检查及血糖监测,改善母婴预后,减少并发症发生。     

妊娠期糖尿病产后管理策略

妊娠期糖尿病的发病率逐年增加,并且是妇女日后发展为糖尿病、代谢综合征以及心血管疾病的高危因素.因此,妊娠期糖尿病妇女产后管理是降低产后并发症的重要手段.妊娠期糖尿病妇女的产后管理包括:产后血糖筛查、糖尿病相关知识的教育、改变生活方式的措施以及产后避孕等多方面.目前,妊娠期糖尿病的产后管理工作仍十分欠缺,需要多个学科密切...     

妊娠期糖尿病健康生活方式管理

妊娠期糖尿病是妊娠期常见并发症,生活方式干预是妊娠期糖尿病的重要治疗措施。规范、专业、多学科团队协作的孕期健康生活方式管理有助于调控血糖,改善妊娠期糖尿病不良妊娠结局及母儿预后。     

妊娠期糖尿病患者的产后管理策略

妊娠期糖尿病(gestational diabetes mellitus,GDM)患者及其子代均是2型糖尿病(type 2 diabetes mellitus,T2DM)患病的高危人群,针对这一群体进行合理干预,是预防T2DM的第一道防线.产后血糖监测和随访管理具有重要社会价值和经济效益.本文通过强化GDM母儿远期不良...     

浅谈大数据时代妊娠期糖尿病患者健康教育模式

全球妊娠期糖尿病患病率升高,给母儿预后带来不良影响.健康教育是妊娠期糖尿病管理的重要措施之一,能有效提高孕妇的自我管理能力,控制血糖水平,改善妊娠结局.本文通过比较国内外大数据模式下健康教育方式、内容、运行模式等,分析在大数据背景下妊娠期糖尿病宣教不同模式的利与弊,探讨如何完善基于互联网下妊娠期糖尿病健康宣教模式,旨在...     

控制血糖对改善妊娠期糖尿病孕妇妊娠结局的意义

目的:探讨控制妊娠期糖尿病孕妇血糖对减少母体及围生儿并发症和改善妊娠结局的意义.方法:将70例妊娠期糖尿病孕妇根据治疗后血糖控制情况分成血糖控制满意组(A组,54例)与血糖控制不满意组(B组,16例),同80例正常孕妇的妊娠过程进行比较,分析在孕产妇和围生儿并发症方面有无差异.结果:经临床治疗后,A组只有妊娠期高血压疾病发生率高于对照组孕妇(P＜0.05),B组妊娠期高血压疾病、羊水过多、巨大儿、早产及新生儿窒息发生率均高于对照组(P＜0.05).结论:重视血糖筛查,及时诊断和治疗妊娠期糖尿病,选择合适的时间和方式终止妊娠可以有效的降低母儿并发症的发生率.     

Continuous glucose monitoring: a stepping stone in the journey towards a cure for diabetes.

Probably the most important advance in the field of diabetes and pregnancy since the discovery of insulin in 1921 is self-monitoring of blood glucose. Within the past 30 years, home monitoring of blood glucose has introduced a more efficient means of tracking patient progress. The advent of continuous glucose monitoring has broadened the horizons for improving patient care. Barriers to intensive therapy such as standard methods of monitoring blood glucose, the risk of hypoglycemia, the limitations of present therapy and inadequate patient education must be overcome in order to improve diabetes management. This paper discusses methods of blood glucose monitoring and its aims at bringing the above mentioned barriers to a minimum in order to maintain normoglycemia, to reduce risks of diabetes-related complications and to optimize the possibility for pregnant women with diabetes of delivering healthy babies.     

Intrapartum application of the continuous glucose monitoring system in pregnancies complicated with diabetes: A review and feasibility study

Intrapartum maternal normoglycemia seems to play an important role in the prevention of adverse perinatal, maternal and neonatal outcomes. Several glucose monitoring protocols have been developed, aiming to achieve a tight glucose monitoring and control. Depending on the type of diabetes and the optimal or suboptimal glycemic control, the treatment options include fasting status of the parturient, frequent monitoring of capillary blood glucose, intravenous dextrose infusion and subcutaneous or intravenous use of insulin. Continuous glucose monitoring system (CGMS) is a relatively new technology that measures interstitial glucose at very short time intervals over a specific period of time. The resulting profile provides a more comprehensive measure of glycemic excursions than intermittent home blood glucose monitoring. Results of studies applying the CGMS technology in patients with or without diabetes mellitus (DM) have revealed new insights in glucose metabolism. Moreover, CGMS have a potential role in the improvement of glycemic control during pregnancy and labor, which may lead to a decrease in perinatal morbidity and mortality. In conclusion, the use of CGMS, with its important technical advantages compared to the conventional way of monitoring, may lead into a more etiological intrapartum management of both the mother and her fetus/infant in pregnancies complicated with DM.     

Continuous glucose monitoring for the evaluation of gravid women with type 1 diabetes mellitus

OBJECTIVE: To compare the daily glycemic profile reflected by continuous and intermittent blood glucose monitoring in pregnant women with type 1 diabetes and to compare the treatment protocols based on the two monitoring methods. METHODS: The study sample consisted of 34 gravid patients at gestational weeks 16-32, with type 1 diabetes being treated by multiple insulin injections. Data derived from the continuous glucose monitoring system for 72 hours were compared with finger stick glucose measurements performed 6-8 times per day. During the study period, patients documented the time of food intake, insulin injections, and hypoglycemic events. Data on demographics, gravidity, parity, body mass index, hemoglobin A1c, and fructosamine levels were collected for each patient. RESULTS: An average (+/- standard deviation) of 780 +/- 54 glucose measurements was recorded for each patient with continuous glucose monitoring. The mean total time of hyperglycemia (glucose level greater than 140 mg/dL) undetected by the finger stick method was 192 +/- 28 minutes per day. Nocturnal hypoglycemic events (glucose level less than 50 mg/dL) were recorded in 26 patients; in all cases, there was an interval of 1-4 hours before clinical manifestations appeared or the event was revealed by random blood glucose examination. Based on the additional information obtained by continuous monitoring, the insulin therapeutic regimen was adjusted in 24 patients (70%). CONCLUSION: Continuous glucose monitoring can diagnose high postprandial blood glucose levels and nocturnal hypoglycemic events that are unrecognized by intermittent blood glucose monitoring and may serve as a basis for determining treatment regimens. A large, prospective study on maternal and neonatal outcome is needed to evaluate the clinical implications of this new monitoring technique.     

Continuous glucose monitoring for the evaluation and improved control of gestational diabetes mellitus

Objectives: To compare the daily glycemic profile reflected by continuous versus self-monitoring of blood glucose in women with gestational diabetes mellitus (GDM), and to evaluate possible differences in treatment strategy based on the two monitoring methods. Materials and methods: The study sample consisted of 57 women with gestational diabetes, 47 in Israel and ten in California. Gestational age ranged from 24 to 32 weeks in the Israeli women, and 32 to 36 weeks in the American women. Data derived from the Continuous Glucose Monitoring (CGM) System (MiniMed) for 72 h were compared to fingerstick glucose measurements (6-8 times a day). During continuous monitoring, patients documented the timing of food intake, insulin injections and hypoglycemic events. Results: In the Israeli group, 23 women were treated by diet alone, and 24 by diet plus insulin. An average of 763 ± 62 glucose measurements was recorded for each patient with continuous glucose monitoring. The mean total time of hyperglycemia (glucose level > 140 mg/dl) undetected by the fingerstick method was 132 ± 31 min/day in the insulin-treated group and 94 ± 23 min/day in the diet-treated group. Nocturnal hypoglycemic events (glucose levels < 50 mg/dl) were recorded in 14 patients, all insulin-treated. On the basis of the additional information provided by continuous monitoring, the therapeutic regimen (insulin therapy, diet adjustment, or both) was changed in 36 of the 47 patients. All ten American women were treated with insulin. The mean time of undetected hyperglycemia for a total group monitoring time of 30 days was 78 ± 13 min/day. Eight women had nocturnal hypoglycemia on at least one of the three nights of monitoring for a total of 12 nights. A change in insulin dosage was made in all women on the basis of the data provided by continuous glucose monitoring. Conclusion: Continuous glucose monitoring is helpful for monitoring women with GDM and for adjusting diabetes therapy. It can accurately detect high postprandial blood glucose levels and nocturnal hypoglycemic events that may go unrecognized by intermittent blood glucose monitoring. A large prospective study on maternal and neonatal outcome is needed to determine the clinical implications of this new monitoring technique.     

Measuring and managing hyperglycemia in pregnancy: from glycosuria to continuous blood glucose monitoring

The need to accurately detect and monitor hyperglycemia in pregnancy is becoming more apparent as the incidence of pregestational and gestational diabetes is increasing, especially among adolescents. The risk of adverse perinatal outcome is markedly worsened when pregnancy is complicated by elevated blood glucose. The appropriate management of both pregestational and gestational diabetes as it relates to blood glucose targets is clear. In the past 5 years, a number of studies have concluded that tight glycemic control throughout pregnancy significantly reduces both fetal and maternal risk. These studies have proposed blood glucose targets between 70 to 120 mg/dL. They have concluded that blood glucose levels should be the basis of moving rapidly to more effective treatments. The key to this approach is the adoption of blood glucose monitoring as an integral part of the treatment regimen. To assure sufficient data on which clinical decisions are made, the type of device, frequency of monitoring, and interpretation of results need to be carefully considered.     

孕期血糖监测频率对饮食控制的妊娠期糖尿病围产结局的影响

目的:探讨血糖监测频率对饮食控制的妊娠期糖尿病(GDM)孕妇围产结局的影响.方法:选取2015年11月至2018年4月在浙江大学医学院附属妇产科医院产检并分娩单胎、孕前无糖尿病高血压疾病的5453例饮食控制的GDM孕妇.根据OGTT试验时的血糖水平将孕妇分为高危组[2699例(49.5％)]和低危组[2754例(50....     

Insulin pump therapy for pregnancy: a primer

Current knowledge and advances in insulin formulations, insulin pump technology, and blood glucose monitoring techniques have improved practitioners’ ability to achieve diabetic people’s blood glucose targets. Practitioners and pregnant women should bear in mind that important differences exist in glucose metabolism during pregnancy and require a different approach from non-pregnant people to avoid pregnant women’s experience being adversely affected. Insulin pump therapy, if used skillfully by practitioners and their pregnant patients, can be especially beneficial for some diabetic women during their pregnancies. Women’s healthcare practitioners should endeavor to be familiar with this therapy, even if they are not experts in its full complexity.     

Antenatal nonstress test in complicated and uncomplicated pregnancies in type-1-diabetic women

111 pregnant women with type-1 diabetes were cared for at the Karolinska Hospital from 1979 to 1986. As routine fetal monitoring, a non-stress test (NST) was performed twice weekly from the 35th or 36th week of gestation to delivery. If pregnancy complications occurred, an NST was still used for fetal monitoring, but more frequently. The median gestational age at delivery was 270 days. The mean maternal blood glucose during the third trimester was 6.0 mmol/l. In 88 of the totally 111 women the only indication for an NST was the patient's diabetes. In this routinely monitored group, 2/88 patients had abnormal NSTs and cesarean sections were performed. The neonatal outcome was good in both cases. Twenty-three had such complications as pre-eclampsia or IUGR, and in these cases the frequency of an NST was individualized. Four of these 23 had abnormal NSTs leading to cesarean sections. There were no signs of asphyxia among these four infants. Thus, in diabetic pregnancies with a well-regulated blood glucose, intervention due to abnormal fetal monitoring is more associated with acute pregnancy complications than the diabetes per se. The results of this study suggest that antenatal NSTs twice a week from week 35-36 is sufficient in well blood-glucose regulated type-1-diabetic women with a well-regulated blood glucose. If pregnancy complications occur, the NST, in an individualized frequency, seems to be a safe way of fetal monitoring.     

Complementary therapies and diabetes

There is increasing recognition that people with diabetes use a range of complementary therapies (CT), for a number of conditions, but do not always inform their conventional health practitioners about their use. Controlling blood glucose levels in people with diabetes is important to reduce the consequent metabolic abnormalities and symptoms and the incidence of long-term complications. Conventional medical and nursing practitioners often incorrectly assume that they are used to control blood glucose levels, e.g. using herbal medicines to increase insulin production or reduce insulin resistance. CT can be beneficial for people with diabetes. They can also lead to adverse events. This paper describes the outcome of monitoring complementary therapy use in our diabetic outpatient services in 2001, the results of a focus group (n=10) to explore issues identified in the monitoring process and a survey undertaken with a convenience sample of diabetes educators (n=40).Twenty percent of patients used CT and there were three adverse events in the monitoring phase. Eight of the 10 focus group participants used CT and 16 of the diabetes educators used CT in patient care. Only one had a complementary therapy qualification.     

Preprandial versus postprandial blood glucose monitoring in type 1 diabetic pregnancy: a randomized controlled clinical trial

OBJECTIVE: This study was undertaken to compare preprandial and postprandial capillary glucose monitoring in pregnant women with type 1 diabetes. STUDY DESIGN: Sixty-one women with type 1 diabetes were randomly assigned at 16 weeks' gestation to preprandial or postprandial blood glucose monitoring using memory-based glucose reflectance meters throughout pregnancy. Serial measurements of hemoglobin A1c and fructosamine were obtained throughout pregnancy. Insulin, glucose, and insulin-like growth factor-I (IGF-I) were measured in cord blood at delivery. Neonatal anthropometric measures were performed within 72 hours of delivery RESULTS: Maternal age, parity, age of onset of diabetes, number of prior miscarriages, smoking status, social class, weight gain in pregnancy, and compliance with therapy were similar in the two groups. The postprandial monitoring group had a significantly reduced incidence of preeclampsia (3% vs 21%, P<.048), a greater success in achieving glycemic control targets (55% vs 30%, P<.001) and a smaller neonatal triceps skinfold thickness (4.5+/-0.9 vs 5.1+/-1.3, P=.05). CONCLUSION: Postprandial capillary blood glucose monitoring in type 1 diabetic pregnancy may significantly reduce the incidence of preeclampsia and neonatal triceps skinfold thickness compared with preprandial monitoring.