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Gestational Diabetes Mellitus Treatment

Gestational Diabetes

Gestational Diabetes

Gestational diabetes definition and facts Risk factors for gestational diabetes include a history of gestational diabetes in a previous pregnancy, There are typically no noticeable signs or symptoms associated with gestational diabetes. Gestational diabetes can cause the fetus to be larger than normal. Delivery of the baby may be more complicated as a result. The baby is also at risk for developing low blood glucose (hypoglycemia) immediately after birth. Following a nutrition plan is the typical treatment for gestational diabetes. Maintaining a healthy weight and following a healthy eating plan may be able to help prevent or minimize the risks of gestational diabetes. Women with gestational diabetes have an increased risk of developing type 2 diabetes after the pregnancy What is gestational diabetes? Gestational diabetes is diabetes, or high blood sugar levels, that develops during pregnancy. It occurs in about 4% of all pregnancies. It is usually diagnosed in the later stages of pregnancy and often occurs in women who have no prior history of diabetes. What causes gestational diabetes? Gestational diabetes is thought to arise because the many changes, hormonal and otherwise, that occur in the body during pregnancy predispose some women to become resistant to insulin. Insulin is a hormone made by specialized cells in the pancreas that allows the body to effectively metabolize glucose for later usage as fuel (energy). When levels of insulin are low, or the body cannot effectively use insulin (i.e., insulin resistance), blood glucose levels rise. What are the screening guidelines for gestational diabetes? All pregnant women should be screened for gestational diabetes during their pregnancy. Most pregnant women are tested between the 24th and 28th weeks of pregnancy (see Continue reading >>

Glyburide: A Safe And Effective Medication For The Treatment Of Gestational Diabetes?

Glyburide: A Safe And Effective Medication For The Treatment Of Gestational Diabetes?

This study investigated if glyburide(Glynase) was safer and more effective than insulin in patients with gestational diabetes. They found that glyburide was associated with an increased risk of neonatal hypoglycemia (low blood sugar) but was well tolerated overall. Gestational diabetes mellitus (GDM) occurs when pregnant women develop glucose intolerance leading to high blood glucose during the pregnancy. This can increase the risk of negative outcomes for both the mother and child.GDM can be treated either with lifestyle modifications (diet, exercise) or using medication. Insulin therapy is the first-line of treatment however not all women respond adequately. Glyburide is a sulfonylurea which can be taken orally. These types of medications can stimulate cells in the pancreas to produce insulin. Insulin is the hormone needed to break down the glucose taken in from food. The safety and efficacy of glyburide for the treatment of GDM has not been well established. This study analyzed the results from clinical trials examiningglyburidein GDM treatment. This study included data from 10 clinical trials. Patients were receiving either insulin or glyburide treatment for GDM. The effect of these drugs on maternal outcomes (effects on the mother) and neonatal outcomes (effects on the child) were compared. Mothers receiving glyburide or insulin had similar maternal outcomes including blood sugar management, severe hypoglycemia (low blood sugar), risk of preterm birth and pre-eclampsia. Glyburide was associated with an 89% increased risk of high blood glucose in the baby (neonatal hypoglycemia). This study concluded that glyburide is a safe and effective medication for the treatment of GDM, however monitoring for neonatal hypoglycemia is essential. This study compared data from 10 Continue reading >>

Gestational Diabetes Mellitus—right Person, Right Treatment, Right Time?

Gestational Diabetes Mellitus—right Person, Right Treatment, Right Time?

Abstract Personalised treatment that is uniquely tailored to an individual’s phenotype has become a key goal of clinical and pharmaceutical development across many, particularly chronic, diseases. For type 2 diabetes, the importance of the underlying clinical heterogeneity of the condition is emphasised and a range of treatments are now available, with personalised approaches being developed. While a close connection between risk factors for type 2 diabetes and gestational diabetes has long been acknowledged, stratification of screening, treatment and obstetric intervention remains in its infancy. Although there have been major advances in our understanding of glucose tolerance in pregnancy and of the benefits of treatment of gestational diabetes, we argue that far more vigorous approaches are needed to enable development of companion diagnostics, and to ensure the efficacious and safe use of novel therapeutic agents and strategies to improve outcomes in this common condition. Background May 2018 will mark 10 years since the publication of the seminal Hyperglycemia and Adverse Pregnancy Outcomes Study (HAPO) [1] and 8 years since new criteria and pathway for diagnosis of gestational diabetes (GDM) were proposed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) [2]. Landmark studies of the treatment of 'mild' GDM had been published before this in 2005 [3] and 2009 [4]. The IADPSG criteria have been largely adopted by several national and international societies, notably by the World Health Organisation (WHO) [5] and International Federation of Gynecology and Obstetrics (FIGO) [6], but others, most influentially the American College of Obstetricians and Gynecologists (ACOG) [7] and the National Institute for Health and Care Excellence (NIC Continue reading >>

Patient Education: Gestational Diabetes Mellitus (beyond The Basics)

Patient Education: Gestational Diabetes Mellitus (beyond The Basics)

INTRODUCTION Insulin is a hormone whose job is to enable glucose (sugar) in the bloodstream to enter the cells of the body, where sugar is the source of energy. All fetuses (babies) and placentas (afterbirths) produce hormones that make the mother resistant to her own insulin. Most pregnant women produce more insulin to compensate and keep their blood sugar level normal. Some pregnant women cannot produce enough extra insulin and their blood sugar level rises, a condition called gestational diabetes. Gestational diabetes affects between 5 and 18 percent of women during pregnancy, and usually goes away after delivery. It is important to recognize and treat gestational diabetes to minimize the risk of complications to mother and baby. In addition, it is important for women with a history of gestational diabetes to be tested for diabetes after pregnancy because of an increased risk of developing type 2 diabetes in the years following delivery. More detailed information about gestational diabetes is available by subscription. (See "Diabetes mellitus in pregnancy: Screening and diagnosis".) GESTATIONAL DIABETES TESTING We recommend that all pregnant women be tested for gestational diabetes. Identifying and treating gestational diabetes can reduce the risk of pregnancy complications. (See "Diabetes mellitus in pregnancy: Screening and diagnosis".) Complications of gestational diabetes can include: Having a large baby (weighing more than 9 lbs or 4.1 kg), which can increase the risk of injury to the mother or baby during delivery and increase the chance of needing a cesarean section. Stillbirth (a baby who dies before being born), a complication which fortunately is now rare in women with gestational diabetes because of good control of blood sugars and careful monitoring of mo Continue reading >>

Management Of Gestational Diabetes Mellitus

Management Of Gestational Diabetes Mellitus

Gestational diabetes mellitus is a common but controversial disorder. While no large randomized controlled trials show that screening for and treating gestational diabetes affect perinatal outcomes, multiple studies have documented an increase in adverse pregnancy outcomes in patients with the disorder. Data on perinatal mortality, however, are inconsistent. In some prospective studies, treatment of gestational diabetes has resulted in a decrease in shoulder dystocia (a frequently discussed perinatal outcome), but cesarean delivery has not been shown to reduce perinatal morbidity. Patients diagnosed with gestational diabetes should monitor their blood glucose levels, exercise, and undergo nutrition counseling for the purpose of maintaining normoglycemia. The commonly accepted treatment goal is to maintain a fasting capillary blood glucose level of less than 95 to 105 mg per dL (5.3 to 5.8 mmol per L); the ambiguity (i.e., the range) is due to imperfect data. The postprandial treatment goal should be a capillary blood glucose level of less than 140 mg per dL (7.8 mmol per L) at one hour and less than 120 mg per dL (6.7 mmol per L) at two hours. Patients not meeting these goals with dietary changes alone should begin insulin therapy. In patients with well-controlled diabetes, there is no need to pursue delivery before 40 weeks of gestation. In patients who require insulin or have other comorbid conditions, it is appropriate to begin antenatal screening with nonstress tests and an amniotic fluid index at 32 weeks of gestation. Screening for gestational diabetes mellitus is widely practiced despite lack of evidence that it prevents adverse perinatal outcomes. Although the disorder affects approximately 2.5 percent of pregnant women1 and has been the subject of extensive res Continue reading >>

Treatment: Evidence Summary

Treatment: Evidence Summary

A Systematic Review and Meta-Analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research By: Lisa Hartling, PhD; Donna M. Dryden, PhD; Alyssa Guthrie, MSSc; Melanie Muise, MA; Ben Vandermeer, MSc; and Lois Donovan, MD The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment. This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This report was first published in the Annals of Internal Medicine on May 28, 2013 (Ann Intern Med 2013; Select for copyright and source information . Background: Outcomes of treating gestational diabetes mellitus (GDM) are not well-established. Purpose: To summarize evidence about the maternal and neonatal benefits and harms of treating GDM. Data Sources: 15 electronic databases from 1995 to May 2012, gray literature, Web sites of relevant organizations, trial registries, and reference lists. Study Selection: English-language randomized, controlled trials (n = 5) and cohort studies (n = 6) of women without known preexisting diabetes. Data Extraction: One reviewer extracted data, and a second reviewer verified them. Two reviewers independently assessed methodological quality and evaluated strength of evidence for primary outcomes by using a Grading of Recommendations Assessment, Development and Evaluation approach Continue reading >>

Current Management Of Gestational Diabetes Mellitus

Current Management Of Gestational Diabetes Mellitus

Current Management of Gestational Diabetes Mellitus Guido Menato; Simona Bo; Anna Signorile; Marie-Laure Gallo; Ilenia Cotrino; Chiara Botto Poala; Marco Massobrio Expert Rev of Obstet Gynecol.2008;3(1):73-91. Treatment of Gestational Diabetes Mellitus Diet is the mainstay of treatment in GDM whether or not pharmacologic therapy is introduced. Dietary control with a reduction in fat intake and the substitution of complex carbohydrates for refined carbohydrates seeks to achieve and maintain the maternal blood glucose profile essential during gestation. Two approaches are recommended: decreasing the proportion of carbohydrates to 40% in a daily regimen of three meals and three or four snacks, or lowering the glycemic index so that carbohydrates make up approximately 60% of the daily intake.[ 9 , 10 , 11 , 12 ] The ADA also recommends nutritional counseling, if possible by a registered dietitian, with individualization of the nutrition plan based on height and weight.[ 13 ] For normal-weight women (BMI: 20-25 kg/m2) 30 kcal/kg should be prescribed; for overweight and obese women (BMI > 24-34 kg/m2) calories should be restricted to 25 kcal/kg, and for morbidly obese women (BMI > 34 kg/m2) calories should be restricted to 20 kcal/kg or less.[ 12 ] In normal pregnancy expected weight gain varies according to the prepregnancy weight. The Fifth International Workshop-Conference on GDM recommends a relatively small gain during pregnancy of 7 kg (15 lb) or more for obese women (BMI 30 kg/m2) and a proportionally greater weight gain (up to 18 kg or 40 lb) for underweight women (BMI < 18.5 kg/m2) at the onset of pregnancy. However, there are no data on optimal weight gain for women with GDM.[ 14 ] Caloric composition includes 40-50% from complex, high-fiber carbohydrates, 20% from Continue reading >>

Treatment

Treatment

If you have gestational diabetes, the chances of having problems with the pregnancy can be reduced by controlling your blood sugar (glucose) levels. You'll also need to be more closely monitored during pregnancy and labour to check if treatment is working and to check for any problems. Checking your blood sugar level You'll be given a testing kit that you can use to check your blood sugar level. This involves using a finger-pricking device and putting a drop of blood on a testing strip. You'll be advised: how to test your blood sugar level correctly when and how often to test your blood sugar – most women with gestational diabetes are advised to test before breakfast and one hour after each meal what level you should be aiming for – this will be a measurement given in millimoles of glucose per litre of blood (mmol/l) Diabetes UK has more information about monitoring your glucose levels. Diet Making changes to your diet can help control your blood sugar level. You should be offered a referral to a dietitian, who can give you advice about your diet, and you may be given a leaflet to help you plan your meals. You may be advised to: eat regularly – usually three meals a day – and avoid skipping meals eat starchy and low glycaemic index (GI) foods that release sugar slowly – such as wholewheat pasta, brown rice, granary bread, all-bran cereals, pulses, beans, lentils, muesli and porridge eat plenty of fruit and vegetables – aim for at least five portions a day avoid sugary foods – you don't need a completely sugar-free diet, but try to swap snacks such as cakes and biscuits for healthier alternatives such as fruit, nuts and seeds avoid sugary drinks – sugar-free or diet drinks are better than sugary versions; be aware that fruit juices and smoothies contain s Continue reading >>

Gestational Diabetes - Treatment Overview

Gestational Diabetes - Treatment Overview

Most women who have gestational diabetes give birth to healthy babies. You are the most important person in promoting a healthy pregnancy. Treatment for gestational diabetes involves making healthy choices. Most women who make changes in the way that they eat and how often they exercise are able to keep their blood sugar level within a target range. Controlling your blood sugar is the key to preventing problems during pregnancy or birth. You, your doctor, and other health professionals will work together to develop a treatment plan just for you. You do not need to eat strange or special foods. But you may need to change what, when, and how much you eat. And walking several times a week can really help your blood sugar. The lifestyle changes you make now will help you have a healthy pregnancy and prevent diabetes in the future. As you start making these changes, you will learn more about your body and how it reacts to food and exercise. You may also notice that you feel better and have more energy. During pregnancy Treatment for gestational diabetes during pregnancy includes: Eating balanced meals. After you find out that you have gestational diabetes, you will meet with a registered dietitian to create a healthy eating plan. You will learn how to limit the amount of carbohydrate you eat as a way to control your blood sugar. You may also be asked to write down everything you eat and to keep track of your weight. You will learn more about the range of weight gain that is good for you and your baby. Going on a diet during pregnancy is NOT recommended. Getting regular exercise. Try to do at least 2½ hours a week of moderate exercise.3, 4 One way to do this is to be active 30 minutes a day, at least 5 days a week. It's fine to be active in blocks of 10 minutes or more throu Continue reading >>

Gestational Diabetes Treatment

Gestational Diabetes Treatment

Like type 2 diabetes, gestational diabetes develops when liver, muscle, and fat cells don't respond well to insulin — a hormone that regulates glucose (sugar) levels in the blood. As its name suggests, gestational diabetes develops only in pregnant women. It's caused by changes in the body (including changing hormone levels) during pregnancy, and causes high blood glucose levels. If left uncontrolled, the condition may be harmful — or even deadly — to both the woman and her child, and can increase both of their risks of developing type 2 diabetes later in life. The key to treating gestational diabetes is to tightly regulate blood glucose levels through lifestyle changes (diet and exercise) and, if necessary, medications. Gestational Diabetes Diet Treatment for gestational diabetes always includes specialized healthy meal plans — often recommended by a registered dietician — and regular exercise, according to the American Diabetes Association (ADA). Generally speaking, diets for gestational diabetes focus on foods high in fiber and other important nutrients, and low in fat and calories. This means they tend to favor vegetables, fruits, and whole grains, and frown on refined carbohydrates (including sugar). According to a 2008 report in the journal Reviews in Obstetrics and Gynecology, a diet that can help most women with gestational diabetes maintain a normal blood glucose level is one in which 33 to 40 percent of calories come from complex carbohydrates, 35 to 40 percent come from fat, and 20 percent come from protein. Eating regular small meals throughout the day can also help keep your blood glucose level stable. Exercise as Treatment for Gestational Diabetes Regular physical activity is important to help keep your blood glucose under control. Women with ges Continue reading >>

Pharmacological Treatment Of Gestational Diabetes Mellitus: Point/counterpoint - Sciencedirect

Pharmacological Treatment Of Gestational Diabetes Mellitus: Point/counterpoint - Sciencedirect

Pharmacological treatment of gestational diabetes mellitus: point/counterpoint Author links open overlay panel OdedLangerMD, PhD Get rights and content Controversies persist over the most efficacious pharmacologic treatment for gestational diabetes mellitus. For purposes of accuracy in this article, the individual American College of Obstetricians and Gynecologists Practice Bulletin and American Diabetes Association Standards of Medical Care positions on each issue are quoted and then deliberated with evidence of counter claims presented in point/counterpoint. This is a review of all the relevant evidence for the most holistic picture possible. The main issues are (1) which diabetic drugs cross the placenta, (2) the quality of evidence and data source validity, (3) the rationale for the designation of glucose control as the primary outcome in gestational diabetes mellitus, and (4) which drugs (metformin, glyburide, or insulin) are most effective in improving secondary outcomes. The concept that 1 drug fits all, whether it be insulin, glyburide, or metformin, is a fallacy. Different drugs provide certain benefits but not all the benefits and not to all patients. In addition, the steps in the gestational diabetes mellitus management decision path and the current cost of the use of insulin, glyburide, or metformin are addressed. In the future, we must consider studying the potential of diabetic drugs that currently are used in nonpregnancy and incorporating the concept of precision medicine in the decision tree to maximize pregnancy outcomes. Continue reading >>

Diagnosis

Diagnosis

Print Medical experts haven't agreed on a single set of screening guidelines for gestational diabetes. Some question whether gestational diabetes screening is needed if you're younger than 25 and have no risk factors. Others say that screening all pregnant women is the best way to identify all cases of gestational diabetes. When to screen Your doctor will likely evaluate your risk factors for gestational diabetes early in your pregnancy. If you're at high risk of gestational diabetes — for example, your body mass index (BMI) before pregnancy was 30 or higher or you have a mother, father, sibling or child with diabetes — your doctor may test for diabetes at your first prenatal visit. If you're at average risk of gestational diabetes, you'll likely have a screening test during your second trimester — between 24 and 28 weeks of pregnancy. Routine screening for gestational diabetes Initial glucose challenge test. You'll drink a syrupy glucose solution. One hour later, you'll have a blood test to measure your blood sugar level. A blood sugar level below 130 to 140 milligrams per deciliter (mg/dL), or 7.2 to 7.8 millimoles per liter (mmol/L), is usually considered normal on a glucose challenge test, although this may vary by clinic or lab. If your blood sugar level is higher than normal, it only means you have a higher risk of gestational diabetes. You'll need a glucose tolerance test to determine if you have the condition. Follow-up glucose tolerance testing. You'll fast overnight, then have your blood sugar level measured. Then you'll drink another sweet solution — this one containing a higher concentration of glucose — and your blood sugar level will be checked every hour for three hours. If at least two of the blood sugar readings are higher than normal, you'll Continue reading >>

Treatment Of Gestational Diabetes Mellitus

Treatment Of Gestational Diabetes Mellitus

SUMMARY Objective. To determine whether treatment of women with mild gestational diabetes mellitus (GDM), i.e., GDM that would meet the criteria for impaired glucose tolerance (IGT) in the nonpregnant state, decreases the risk of perinatal complications and to assess the effects of treatment on maternal outcome, mood, and quality of life. Design. At the time this trial was initiated, the World Health Organization (WHO) recommended that the management of IGT during pregnancy should be the same as for diabetes,1 a recommendation that differed from that of the National Diabetes Data Group.2 The trial reported by Crowther et al. and reviewed here enrolled only women who fit into this controversial category. Researchers at multiple centers in Australia and the United Kingdom randomly assigned 1,000 women who were diagnosed with GDM at 24-34 weeks of gestation to either an intervention group or a routine-care group. They admitted to the study only women with one or more risk factors for diabetes or a positive 50-g oral glucose challenge test in addition to a fasting glucose of < 140 mg/dl and a 75-g oral glucose tolerance test 2-hour glucose concentration of 140-199 mg/dl. The intervention group received individualized dietary advice, instructions on glucose self-monitoring and insulin therapy, and routine primary care, whereas the routine-care group received only routine primary care. End points. End points included the rate of serious perinatal outcomes, defined as death, shoulder dystocia, bone fracture, and nerve palsy, as well as less-serious outcomes, including admission to the neonatal nursery, jaundice, induction of labor, cesarean birth, and maternal anxiety, depression, and health status. Results. This study revealed a significantly lower rate of serious perinatal o Continue reading >>

Gestational Diabetes Mellitus: Diet, Treatment And What To Expect - Healthxchange

Gestational Diabetes Mellitus: Diet, Treatment And What To Expect - Healthxchange

Gestational Diabetes Mellitus: Diet, Treatment and What to Expect Gestational Diabetes Mellitus: Diet, Treatment and What to Expect Find out the treatment options and diet tips for gestational diabetes mellitus, shared by Dr Lim Weiying, Associate Consultant, Dept of Endocrinology, and Ms Kala Adaikan, Senior Principal Dietitian, Dept of Dietetics, at Singapore General Hospital. is usually the first method of treatment for gestational diabetes mellitus. Treatment for gestational diabetes mellitus (GDM) Gestational diabetes mellitus (GDM) usually improves with lifestyle measures such as: "Despite best efforts at lifestyle modification, some women need to take tablets or insulin injections to control their glucose levels. If insulin therapy is required, the technique for self-injection will be taught,"explains Dr Lim Wei Ying , Associate Consultant from the Department of Endocrinology , Singapore General Hospital (SGH), a member of the SingHealth group. You may also be referred to a doctor who specialises in diabetes for further monitoring during your pregnancy. Your blood pressure and urine will be checked at every visit as you have an increased risk of developing pre-eclampsia (high blood pressure condition that develops only during pregnancy). Ultrasound scans will be performed to monitor your babys growth closely. Regular blood tests will also be performed to monitor your blood glucose control. Individualised advice about the timing and type of delivery will also be given to you by the specialist team at an appropriate time. These depend on various factors such as the blood glucose control, size of the baby, blood pressure measurements and previous surgeries, etc. It is essential for blood glucose levels to be controlled at a satisfactory level. Blood glucose levels Continue reading >>

A Review Of Current Treatment Strategies For Gestational Diabetes Mellitus

A Review Of Current Treatment Strategies For Gestational Diabetes Mellitus

Go to: Approximately 90% of diabetes cases in pregnant women are considered gestational diabetes mellitus (GDM). It is well known that uncontrolled glucose results in poor pregnancy outcomes in both the mother and fetus. Worldwide there are many guidelines with recommendations for appropriate management strategies for GDM once lifestyle modifications have been instituted and failed to achieve control. The efficacy and particularly the safety of other treatment modalities for GDM has been the source of much debate in recent years. Studies that have demonstrated the safety and efficacy of both glyburide and metformin in the management of patients with GDM will be reviewed. There is a lack of evidence with other oral and injectable non-insulin agents to control blood glucose in GDM. The role of insulin will be discussed, with emphasis on insulin analogs. Ideal patient characteristics for each treatment modality will be reviewed. In addition, recommendations for postpartum screening of patients will be described as well as recommendations for use of agents to manage subsequent type 2 diabetes in patients who are breastfeeding. Keywords: gestational diabetes, fetal macrosomia, glyburide, hypoglycemia, hypoglycemic agents, insulin, long-acting insulin, short-acting insulin, metformin, postnatal care Continue reading >>

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