1
|
Goldberg A, Ursing C, Ekéus C, Wiberg-Itzel E. Swedish guidelines for type 1 diabetes and pregnancy outcomes: A nationwide descriptive study of consensus and adherence. Prim Care Diabetes 2021; 15:1040-1051. [PMID: 34556439 DOI: 10.1016/j.pcd.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 11/21/2022]
Abstract
AIMS Type 1 diabetes (DM1) during pregnancy and labor is associated with an increased risk of maternal and fetal complications. Evidence-based care is therefore provided in accordance with guidelines. In this study, we aimed to compare all the Swedish guidelines for DM1 during pregnancy and labor in terms of the variables emphasized in the national guidelines from the US and from England and Wales. The second aim was to measure adherence to local guidelines at the four hospitals in Stockholm that cared for pregnant women with DM1 during 2016 and to describe the pregnancy and labor outcomes. METHODS All the Swedish guidelines for DM1 during pregnancy and labor were reviewed on 31 variables. The medical records of 114 women were reviewed according to whether ≥70% of 22 variables in the guidelines were followed. RESULTS No consensus was found in the Swedish guidelines for any of the 31 variables. Some guidelines were contradictory. The pregnancy guidelines were followed in 17.5% of the medical records, 18.4% followed the labor guidelines, and 5.3% followed both guidelines. The onset of labor, mode of delivery and HbA1c in the third trimester varied significantly, depending on the adherence to guidelines. CONCLUSIONS The Swedish guidelines for DM1 during pregnancy and labor lack both consensus and adherence. A national guideline on DM1 during pregnancy and childbirth with high adherence could improve care for pregnant Swedish women with DM1 and their fetuses.
Collapse
Affiliation(s)
- Alexandra Goldberg
- Department of Clinical Science and Education, Karolinska Institutet (KI) Soder Hospital, Stockholm, Sweden.
| | - Carina Ursing
- Department of Clinical Science and Education, Karolinska Institutet (KI) Soder Hospital, Stockholm, Sweden
| | - Cecilia Ekéus
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Eva Wiberg-Itzel
- Department of Clinical Science and Education, Karolinska Institutet (KI) Soder Hospital, Stockholm, Sweden
| |
Collapse
|
2
|
Simmons D. Paradigm Shifts in the Management of Diabetes in Pregnancy: The Importance of Type 2 Diabetes and Early Hyperglycemia in Pregnancy: The 2020 Norbert Freinkel Award Lecture. Diabetes Care 2021; 44:1075-1081. [PMID: 33972313 DOI: 10.2337/dci20-0055] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 02/03/2023]
Abstract
For over 50 years, the diagnosis of gestational diabetes mellitus (GDM) has been based upon an oral glucose tolerance test at 24-28 weeks' gestation. This is the time during pregnancy when insulin resistance is increasing and hyperglycemia develops among those with insufficient insulin secretory capacity to maintain euglycemia. The Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study and the two major randomized controlled trials of treating GDM are based upon recruitment of women at this time during pregnancy. Meanwhile, the increasing prevalence of type 2 diabetes in pregnancy, with its significant risk of adverse pregnancy outcomes, has led to a need to identify undiagnosed diabetes as near to conception as possible. Screening for undiagnosed diabetes early in pregnancy also identifies women with hyperglycemia less than overt diabetes, yet at increased risk of adverse pregnancy outcomes. Such women are more insulin resistant-with higher blood pressure, triglycerides, perinatal mortality, and neonatal hypoglycemia with a greater need for insulin treatment-than those with GDM diagnosed at 24-28 weeks' gestation. Currently, there is uncertainty over how to diagnose GDM early in pregnancy and the benefits and harms from using the current management regimen. Randomized controlled trials testing the criteria for, and treatment of, GDM early in pregnancy are urgently needed to address this existing equipoise. In the meantime, the importance of early or "prevalent GDM" (i.e., mild hyperglycemia present from early [before] pregnancy) warrants interim criteria and thresholds for medication, which may differ from those in use for GDM diagnosed at 24-28 weeks' gestation.
Collapse
Affiliation(s)
- David Simmons
- Macarthur Clinical School, Western Sydney University, Campbelltown, New South Wales, Australia
| |
Collapse
|
3
|
Simmons D. The benefits of the use of the new International Association of Diabetes in Pregnancy Study Groups guidelines for gestational diabetes mellitus. Aust N Z J Obstet Gynaecol 2020; 60:486-488. [PMID: 32506460 DOI: 10.1111/ajo.13167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/28/2020] [Indexed: 11/27/2022]
Affiliation(s)
- David Simmons
- Macarthur Diabetes Service, Campbelltown Hospital, Campbelltown, New South Wales, Australia.,Macarthur Clinical School, Western Sydney University, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Abstract
Although it has been accepted for decades that women with gestational diabetes mellitus (GDM) are at high risk for future development of type 2 diabetes, vigorous debate regarding the value of detecting and treating GDM has persisted into the twenty-first century. Although results from 2 randomized trials provide strong evidence that treating GDM reduces adverse perinatal outcomes, it remains to be determined whether treatment impacts long-term offspring outcomes. Insulin is the first-line pharmacologic treatment and is added when glycemic goals are not met with nutritional modifications. Oral agent use is controversial, as data on long-term offspring outcomes are lacking.
Collapse
Affiliation(s)
- Emily D Szmuilowicz
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, 530-24, Chicago, IL 60611, USA
| | - Jami L Josefson
- Division of Endocrinology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 54, Chicago, IL 60611, USA
| | - Boyd E Metzger
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Tarry Building, Room 12-703, 300 East Superior, Chicago, IL 60611, USA.
| |
Collapse
|
5
|
McCarthy EA, Williamson R, Shub A. Pregnancy outcomes for women with pre‐pregnancy diabetes mellitus in Australian populations, rural and metropolitan: A review. Aust N Z J Obstet Gynaecol 2018; 59:183-194. [DOI: 10.1111/ajo.12913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 09/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Elizabeth A. McCarthy
- Department of Obstetrics and GynaecologyUniversity of Melbourne Melbourne Victoria Australia
- Department of Perinatal MedicineMercy Hospital for Women Melbourne Victoria Australia
| | - Rebecca Williamson
- Department of Obstetrics and GynaecologyUniversity of Melbourne Melbourne Victoria Australia
| | - Alexis Shub
- Department of Obstetrics and GynaecologyUniversity of Melbourne Melbourne Victoria Australia
- Mercy Hospital for Women Melbourne Victoria Australia
| |
Collapse
|
6
|
Yan Y, Liu Z, Liu D. Heterogeneity of glycometabolism in patients with gestational diabetes mellitus: Retrospective study of 1,683 pregnant women. J Diabetes Investig 2017; 8:554-559. [PMID: 27863107 PMCID: PMC5497052 DOI: 10.1111/jdi.12595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/05/2016] [Accepted: 11/06/2016] [Indexed: 01/14/2023] Open
Abstract
AIMS/INTRODUCTION To evaluate the glycometabolism and outcomes of gestational diabetes mellitus (GDM) patients according to the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria in China. MATERIALS AND METHODS According to the results of a 75-g oral glucose tolerance test, 1,683 pregnant women were divided into three groups: (i) an increment GDM group (patients meet the IADPSG criteria, but not the previous Chinese criteria); (ii) a stock GDM group (patients meet both criteria); and (iii) a normal glucose tolerance group. Their glycometabolism outcomes, prepregnancy and postpartum body mass index were compared, as were maternal-fetal outcomes. RESULTS The IADPSG and previous Chinese criteria diagnosed 12.4% and 5.5% of women with GDM. Pairwise comparison showed significant differences in 1-h plasma glucose, 2-h plasma glucose, HbA1c values and area under curve of glucose among all groups (P < 0.01). The fasting plasma glucose and postpartum body mass index of the stock group were significantly higher than those of the other two groups (P < 0.01). The incidences of hypertensive disorder complicating pregnancy and cesarean section of the normal glucose tolerance group were significantly lower than those of the other two groups (P < 0.001). No significant differences in patient age, prepregnancy body mass index, duration of pregnancy, prevalence of premature labor, premature rupture of membranes, neonatal jaundice, neonatal asphyxia or Ponderal Index were observed, but significant differences in macrosomia and neonatal hypoglycemia were observed (P < 0.05). CONCLUSIONS The IADPSG criteria doubled the number of GDM patients. The cases of the increment patients were mild. The IADPSG criteria should be discussed fully before implementation in China.
Collapse
Affiliation(s)
- Yan Yan
- Department of ObstetricsShanghai First Maternity and Infant HospitalTongji UniversityShanghaiChina
| | - Zhou Liu
- Department of Obstetrics and GynecologyShanghai Zhoupu HospitalShanghaiChina
| | - Daqing Liu
- Department of Obstetrics and GynecologyShanghai Seventh People's HospitalShanghaiChina
| |
Collapse
|
7
|
Feig DS, Corcoy R, Jensen DM, Kautzky-Willer A, Nolan CJ, Oats JJN, Sacks DA, Caimari F, McIntyre HD. Diabetes in pregnancy outcomes: a systematic review and proposed codification of definitions. Diabetes Metab Res Rev 2015; 31:680-90. [PMID: 25663190 DOI: 10.1002/dmrr.2640] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/29/2015] [Indexed: 12/18/2022]
Abstract
Rising rates of diabetes in pregnancy have led to an escalation in research in this area. As in any area of clinical research, definitions of outcomes vary from study to study, making it difficult to compare research findings and draw conclusions. Our aim was to compile and create a repository of definitions, which could then be used universally. A systematic review of the literature was performed on published and ongoing randomized controlled trials in the area of diabetes in pregnancy between 01 Jan 2000 and 01 Jun 2012. Other sources included the World Health Organization and Academic Society Statements. The advice of experts was sought when appropriate definitions were lacking. Among the published randomized controlled trials on diabetes and pregnancy, 171 abstracts were retrieved, 64 full texts were reviewed and 53 were included. Among the ongoing randomized controlled trials published in ClinicalTrials.gov, 90 protocols were retrieved and 25 were finally included. The definitions from these were assembled and the final maternal definitions and foetal definitions were agreed upon by consensus. It is our hope that the definitions we have provided (i) will be widely used in the reporting of future studies in the area of diabetes in pregnancy, that they will (ii) facilitate future systematic reviews and formal meta analyses and (iii) ultimately improve outcomes for mothers and babies.
Collapse
Affiliation(s)
- Denice S Feig
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of Endocrinology and Metabolism, Mount Sinai Hospital, Toronto, Canada
| | - Rosa Corcoy
- Servei d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Spain; CIBER-BBN, Madrid, Spain
| | | | - Alexandra Kautzky-Willer
- Internal Medicine III, Endocrinology & Metabolism, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria
| | - Christopher J Nolan
- Department of Diabetes and Endocrinology, The Canberra Hospital and the Australian National University Medical School, Canberra, ACT, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - David A Sacks
- Department of Research and Evaluation, Kaiser Permanente Southern California, CA, USA
| | - Francisca Caimari
- Servei d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - H David McIntyre
- Mater Research Institute and School of Medicine, The University of Queensland, (HDM), Brisbane, Australia
| |
Collapse
|
8
|
Bilous R. Diagnosis of gestational diabetes, defining the net, refining the catch. Diabetologia 2015; 58:1965-8. [PMID: 26173673 DOI: 10.1007/s00125-015-3695-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/30/2015] [Indexed: 12/01/2022]
Abstract
The blood glucose diagnostic thresholds for gestational diabetes remain controversial. In the UK the National Institute for Health and Care Excellence (NICE) has published updated guidance for its diagnosis based upon a health economic analysis using local population datasets, and treatment effects estimated from published intervention trials. The resulting thresholds differ from those of the WHO, and in this issue of Diabetologia (DOI: 10.1007/s00125-015-3647-z ), Meek et al have compared the impact of the two sets of diagnostic criteria on 25,543 pregnant women cared for at their unit in Cambridge, UK. This commentary discusses their paper and its implications for pregnant women in the UK.
Collapse
Affiliation(s)
- Rudy Bilous
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK,
| |
Collapse
|
9
|
Farhanah A, Nasirah MF, Nisak MB, Nor Azlin M, Zalilah M. Current Dietetic Practices in the Management of Gestational Diabetes Mellitus:
A Survey of Malaysian Dietitians. ACTA ACUST UNITED AC 2014. [DOI: 10.3923/ajcn.2014.67.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
10
|
McIntyre HD, Metzger BE, Coustan DR, Dyer AR, Hadden DR, Hod M, Lowe LP, Oats JJ, Persson B. Counterpoint: Establishing consensus in the diagnosis of GDM following the HAPO study. Curr Diab Rep 2014; 14:497. [PMID: 24777652 PMCID: PMC4039030 DOI: 10.1007/s11892-014-0497-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The International Association of Diabetes in Pregnancy Study Groups (IADPSG) recommended a new protocol of 1-step testing with a 75 g oral glucose tolerance test for gestational diabetes in 2010. Since that time, these recommendations have been carefully scrutinized and accepted by a variety of organizations, but challenged or rejected by others. In the current review, we present more details regarding the background to the development of the IADPSG recommendations and seek to place them in context with the available epidemiologic and randomized controlled trial data. In this "counterpoint," we also provide specific rebuttal for errors of fact and disputed contentions provided by Long and Cundy in their 2013 article in Current Diabetes Reports.
Collapse
Affiliation(s)
- H. David McIntyre
- University of Queensland, Mater Medical Research Institute Level 3, Aubigny Place, South Brisbane, Queensland, 4101 Australia, Ph: 61-7-3163-6358, Fax: 61-7-3163-2510,
| | - Boyd E. Metzger
- Northwestern University Feinberg School of Medicine, Chicago, IL, 303 East Chicago Avenue, Tarry 12-703, Chicago, IL 60611, Ph: 312-503-7979, Fax 312-503-0037,
| | - Donald R. Coustan
- Warren Alpert Medical School of Brown University, Women and Infant’s Hospital of Rhode Island, 101 Dudley Street, Providence, RI,02905-2401, Ph: 401 274-1122 Ext 7452, Fax 401 543-7622,
| | - Alan R. Dyer
- Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr., #1400, Chicago, IL, 60611, Ph: 312-908-7919, Fax: 312-503-2707,
| | - David R. Hadden
- Royal Victoria Hospital, Belfast, BT12 6BA UK, Ph/Fax: 0044 2890 667110.
| | - Moshe Hod
- Rabin Medical Center, Tel-Aviv University, Petah-Tiqva, 49100 Israel, Tel: +972 3 937 7400, Fax: +972 3 937 7402, Cell: +972 52 8888899,
| | - Lynn P. Lowe
- Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr., #1400 Chicago, IL, 60611, Ph: 312-503-7217, Fax: 312-503-2707,
| | - Jeremy J.N. Oats
- Royal Women’s Hospital & University of Melbourne, PO Box 5266, Burnley, Victoria, Australia, 3121, Ph: 0407-68-5532
| | - Bengt Persson
- Karolinska Institute, Stockholm, Sweden, Mailing address: Logbacken 2, 13150, Saltsjö-Duvnä, Sweden, Ph: 46-8-7169590,
| |
Collapse
|
11
|
Ogedengbe SO, Ezeani IU. Profile of metabolic abnormalities seen in patients with type 2 diabetes mellitus and their first degree relatives with metabolic syndrome seen in Benin City, Edo state Nigeria. J Diabetes Metab Disord 2014; 13:61. [PMID: 24932458 PMCID: PMC4057575 DOI: 10.1186/2251-6581-13-61] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 05/02/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND To determine the profile of metabolic abnormalities in T2DM persons with metabolic syndrome and their non-diabetic first-degree relatives who also had metabolic syndrome in Benin City. METHODOLOGY This was a cross sectional case controlled study in which convenience sampling technique was used to recruit 106 persons with T2DM, 96 people who are first degree relatives of type 2 diabetic persons and 96 controls using a interviewer administered questionnaire technique. The following were assessed: anthropometric indices, blood pressure, serum lipid profile, fasting blood sugar, proteinuria, and microalbuminuria. The data obtained were analyzed using the statistical software-Statistical package for social sciences [SPSS] version 16. A p-value of less than 0.05 was taken as statistically significant. RESULTS THE MEAN AGE (SD) OF THE STUDY GROUPS WERE: persons living with T2DM: 58.6 ± 11.2 years, control: 57.69 ± 60.8 years and FDR: 57.4 ± 10.6 years. No significant age and sex differences were observed in these groups. There were more females (59.7%) than males (40.3%) with T2DM. The prevalence of MS was 13.5%, 16.7%, and 87.1% in the control, FDR and T2DM patients respectively. For the T2DM group of subjects, impaired fasting glycaemia was the commonest metabolic abnormality followed by microalbuminuria, low HDL cholesterol, high LDL cholesterol, hypercholesterolaemia and hypertriglyceridaemia in decreasing frequency. For the FDR group, low HDL cholesterol was the commonest metabolic abnormality followed by hypertriglyceridaemia, impaired fasting glucose, high LDL cholesterol, hypertriglyceridaemia and microalbuminuria in decreasing frequency. Hypercholesterolemia and low HDL cholesterol were the commonest metabolic abnormalities in the control group. CONCLUSION The prevalence of the MS in persons with T2DM in Nigeria appears to be high. Secondly, there is a high prevalence of lipid abnormalities in all the study groups.
Collapse
Affiliation(s)
- Stephen O Ogedengbe
- Departments of Medicine, University of Benin Teaching Hospital, Benin City and Federal Medical Center, P.M.B 7001, Umuahia, Abia state, Nigeria
| | - Ignatius U Ezeani
- Departments of Medicine, University of Benin Teaching Hospital, Benin City and Federal Medical Center, P.M.B 7001, Umuahia, Abia state, Nigeria
| |
Collapse
|
12
|
van Poppel MNM, Zeck W, Ulrich D, Schest EC, Hirschmugl B, Lang U, Wadsack C, Desoye G. Cord blood chemerin: differential effects of gestational diabetes mellitus and maternal obesity. Clin Endocrinol (Oxf) 2014; 80:65-72. [PMID: 23286837 DOI: 10.1111/cen.12140] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 09/23/2012] [Accepted: 12/27/2012] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Chemerin is a novel adipokine implicated in inflammation and obesity. We hypothesized that foetal chemerin would be elevated in gestational diabetes mellitus (GDM) and correlate with foetal and maternal adiposity. DESIGN Observational, longitudinal study. SUBJECTS AND MEASUREMENTS Foetal chemerin was measured separately in arterial and venous cord blood of 30 infants born to mothers with (n = 15) and without GDM (n = 15), in their mothers in early third trimester and at delivery and in amniotic fluid (week 32) of women with GDM. Expression of chemerin and its receptor in human foetal tissues commercially available and in placental cells was measured by quantitative PCR. Associations between foetal and maternal anthropometric and metabolic variables were assessed in multivariate regression models. RESULTS In GDM, foetal arterial but not venous cord blood chemerin levels were elevated by about 60% (P < 0·05). Venous cord blood chemerin was higher in infants of obese women (P < 0·01). In multivariate analyses, neither amniotic fluid nor cord blood chemerin levels correlated with birth weight or ponderal index. Both arterial and venous chemerin levels were related to maternal chemerin at birth, and arterial chemerin was associated with GDM status in addition. Maternal levels were unaltered in GDM, but higher in maternal obesity. Foetal liver produces fourfold more chemerin mRNA than other foetal tissues, whereas its receptor prevails in spleen. CONCLUSIONS Based on multivariate analyses, foetal growth appears unrelated to foetal chemerin. Maternal obesity and GDM have differential effects on foetal chemerin levels. Site of major production (liver) and action (spleen) differ in human foetal tissues.
Collapse
Affiliation(s)
- Mireille N M van Poppel
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
13
|
|
14
|
Simmons D, Moses RG. Gestational diabetes mellitus: to screen or not to screen?: Is this really still a question? Diabetes Care 2013; 36:2877-8. [PMID: 24065839 PMCID: PMC3781565 DOI: 10.2337/dc13-0833] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
15
|
Sacks DB. Diagnosis of gestational diabetes mellitus: it is time for international consensus. Clin Chem 2013; 60:141-3. [PMID: 24061614 DOI: 10.1373/clinchem.2013.206920] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
| |
Collapse
|
16
|
Abstract
BACKGROUND Gestational diabetes mellitus, defined as diabetes diagnosed during pregnancy that is not clearly overt diabetes, is becoming more common as the epidemic of obesity and type 2 diabetes continues. Newly proposed diagnostic criteria will, if adopted universally, further increase the prevalence of this condition. Much controversy surrounds the diagnosis and management of gestational diabetes. CONTENT This review provides information regarding various approaches to the diagnosis of gestational diabetes and the recommendations of a number of professional organizations. The implications of gestational diabetes for both the mother and the offspring are described. Approaches to self-monitoring of blood glucose concentrations and treatment with diet, oral medications, and insulin injections are covered. Management of glucose metabolism during labor and the postpartum period are discussed, and an approach to determining the timing of delivery and the mode of delivery is outlined. SUMMARY This review provides an overview of current controversies as well as current recommendations for gestational diabetes care.
Collapse
Affiliation(s)
- Donald R Coustan
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI 02905, USA.
| |
Collapse
|
17
|
Aarts MCJ, van der Heijden GJM, Rovers MM, Grolman W. Remarkable differences between three evidence-based guidelines on management of obstructive sleep apnea-hypopnea syndrome. Laryngoscope 2012; 123:283-91. [PMID: 22990949 DOI: 10.1002/lary.23521] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 04/27/2012] [Accepted: 05/24/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to compare available guidelines for the diagnosis and treatment of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) regarding their content, conclusions on the available evidence, and recommendations. STUDY DESIGN Literature review/systematic review. METHODS We retrieved guidelines from Embase, PubMed, Web of Science, and Web sites of several health care improvement centers and with a Google Scholar search. We appraised the quality of selected guidelines according to the Appraisal of Guidelines for Research and Evaluation instrument. For similar clinical questions we compared the conclusions, the attached levels of evidence, and the references used. If differences were found, we checked search strategies, appraisal criteria, and publication date as possible sources for these differences. RESULTS We selected the guidelines on diagnosis and treatment of OSAHS of the Scottish Scottish Intercollegiate Guidelines Network, the Dutch Institute for Healthcare Improvement, and the Institute for Clinical Systems Improvement in the United States for this comparison. For similar clinical questions these three guidelines showed conflicting conclusions (11%-18%), differences in attached levels of evidence (32%-62%), and remarkable discrepancies in cited studies. A plausible reason for these differences is the citation preference for articles from members of the guidelines workgroup and from their own country. Despite different publication dates, more recent guidelines fail to cite earlier published guidelines. CONCLUSIONS Despite the generally accepted approach regarding the development of evidence-based guidelines, remarkable differences exist between guidelines from different countries on the same clinical subject.
Collapse
Affiliation(s)
- Mark C J Aarts
- Department of Otorhinolaryngology, University Medical Centre, Utrecht, The Netherlands.
| | | | | | | |
Collapse
|
18
|
Sadikot SM. The IADSPG criteria for the diagnosis of GDM: has the pendulum swung too far to the other side? Diabetes Metab Syndr 2011; 5:113-114. [PMID: 22813561 DOI: 10.1016/j.dsx.2012.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
19
|
Jacqueminet S, Jannot-Lamotte MF. Therapeutic management of gestational diabetes. DIABETES & METABOLISM 2010; 36:658-71. [DOI: 10.1016/j.diabet.2010.11.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
20
|
|
21
|
|
22
|
Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva AD, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJN, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010. [PMID: 20190296 DOI: 10.2337/dc10-0719] [Citation(s) in RCA: 1091] [Impact Index Per Article: 77.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
23
|
Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva AD, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJN, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33:676-82. [PMID: 20190296 PMCID: PMC2827530 DOI: 10.2337/dc09-1848] [Citation(s) in RCA: 2810] [Impact Index Per Article: 200.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
24
|
Mahmud M, Mazza D. Preconception care of women with diabetes: a review of current guideline recommendations. BMC WOMENS HEALTH 2010; 10:5. [PMID: 20113524 PMCID: PMC2834595 DOI: 10.1186/1472-6874-10-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 01/31/2010] [Indexed: 11/17/2022]
Abstract
Background The prevalence of type 2 diabetes mellitus (T2DM) continues to rise worldwide. More women from developing countries who are in the reproductive age group have diabetes resulting in more pregnancies complicated by T2DM, and placing both mother and foetus at higher risk. Management of these risks is best achieved through comprehensive preconception care and glycaemic control, both prior to, and during pregnancy. The aim of this review was to compare the quality and content of current guidelines concerned with the preconception care of women with diabetes and to develop a summary of recommendations to assist in the management of diabetic women contemplating pregnancy. Methods Relevant clinical guidelines were identified through a search of several databases (MEDLINE, SCOPUS and The Cochrane Library) and relevant websites. Five guidelines were identified. Each guideline was assessed for quality using the AGREE instrument. Guideline recommendations were extracted, compared and contrasted. Results All guidelines were assessed as being of high quality and strongly recommended for use in practice. All were consistent in counselling about the risk of congenital malformation related to uncontrolled blood sugar preconceptionally, ensuring adequate contraception until glycaemic control is achieved, use of HBA1C to monitor metabolic control, when to commence insulin and switching from ACE inhibitors to other antihypertensives. Major differences were in the targets recommended for optimal metabolic control and opinion regarding the usage of metformin as an adjunct or alternative treatment before or during pregnancy. Conclusions International guidelines for the care of women with diabetes who are contemplating pregnancy are consistent in their recommendations; however some are more comprehensive than others. Having established current standards for the preconception care of diabetic women, there is now a need to focus on guideline implementation through an examination of the barriers and enablers to successful implementation, and the applicability of the recommendations in the local setting.
Collapse
Affiliation(s)
- Maimunah Mahmud
- Department of General Practice, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | | |
Collapse
|
25
|
|
26
|
Clark HD, Graham ID, Karovitch A, Keely EJ. Do postal reminders increase postpartum screening of diabetes mellitus in women with gestational diabetes mellitus? A randomized controlled trial. Am J Obstet Gynecol 2009; 200:634.e1-7. [PMID: 19268878 DOI: 10.1016/j.ajog.2009.01.003] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 10/15/2008] [Accepted: 01/12/2009] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Women with previous gestational diabetes mellitus rarely receive the recommended 2-hour oral glucose tolerance test (OGTT) after delivery. We sought to determine whether postal reminders to be sent after delivery to a patient, her physician, or both would increase screening rates. STUDY DESIGN Patients were assigned randomly to 4 groups: reminders sent to both physician and patient, to physician but not patient, or to patient but not physician or no reminders were sent. The primary outcome was the proportion of patients who underwent an OGTT within 1 year after delivery. The secondary outcome was the performance of other postpartum screening tests. RESULTS OGTT rates were significantly increased in the physician/patient reminder group (49/81 women; 60.5%), in the patient-only reminder group (42/76 women; 55.3%), and in the physician-only reminder group (16/31 women; 51.6%) compared with the no reminder group (5/35 women; 14.3%; P < .05). CONCLUSION Postpartum reminders greatly increased screening rates for women with gestational diabetes mellitus.
Collapse
Affiliation(s)
- Heather D Clark
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | | | | | | |
Collapse
|
27
|
King R, Wellard S. Juggling type 1 diabetes and pregnancy in rural Australia. Midwifery 2009; 25:126-33. [PMID: 17509737 DOI: 10.1016/j.midw.2007.01.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 12/12/2006] [Accepted: 01/26/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE to explore the experiences of women with type 1 diabetes, living in rural Australia, while preparing for pregnancy and childbirth. Additionally, we aimed to describe the women's engagement with, and expectations of, health-care providers during this period, and subsequently highlight potential service and informational gaps. DESIGN qualitative research using a collective case-study design; seven women with type 1 diabetes who had given birth within the previous 12 months participated in in-depth interviews about their experiences of pregnancy and birth. Data were analysed thematically. SETTING The experience of type 1 diabetes, preconception preparation and pregnancy among rural Australian women was explored, including interactions with health professionals. PARTICIPANTS seven women aged between 26 and 35 years agreed to be interviewed. The woman had one or two children and had given birth within the past 12 months. FINDINGS rigid narrow control of blood glucose levels before conception and during pregnancy created unfamiliar body responses for women, with hypoglycaemic symptoms disappearing or changing. For example, some women mentioned developing tunnel vision or numbness and tingling around their lips and tongue as different symptoms of hypoglycaemia. Women needed information and support to differentiate between what might be normal or abnormal bodily processes associated with pregnancy, diabetes, or both. The women's preparation for conception and pregnancy was reliant on the level of available expertise and advice. Participants' experiences were coloured by their limited access and interactions with expert health professionals. CONCLUSION women with type 1 diabetes experienced significant hardship during their pregnancy, including a higher incidence of hypoglycaemic episodes, a loss of hypoglycaemic symptom recognition and weight gain. These difficulties were compounded by a scarcity of available information to support the management of their pregnancy and a lack of availability of experienced health professionals. IMPLICATIONS FOR PRACTICE national and international consensus guidelines emphasise the importance of preconception and pregnancy care for women with type 1 diabetes. Close clinical supervision and the development of closer co-operation and partnership between the women and health-care providers before conception and during pregnancy may improve outcomes for these women and their babies. Building confidence in professional care requires increased access to specialist services, increased levels of demonstrated knowledge and expertise and better general community access to information about preparation for pregnancy and birth among women who have type 1 diabetes.
Collapse
Affiliation(s)
- Rosemary King
- School of Nursing, University of Ballarat, PO Box 663, Ballarat, 3353, Victoria, Australia.
| | | |
Collapse
|
28
|
Zeck W, McIntyre HD. Gestational diabetes in rural East Africa: a call to action. J Womens Health (Larchmt) 2008; 17:403-11. [PMID: 18328010 DOI: 10.1089/jwh.2007.0380] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The number of cases of diabetes worldwide has increased significantly in the last decade. Characteristically, the incidence of gestational diabetes (GDM) reflects the incidence of type 2 diabetes mellitus (T2DM) in the background population, which is a warning that a rapid increase in the incidence is to be expected concomitant with the already observed increase in the incidence of T2DM. Although the majority of all deliveries worldwide take place in the so-called developing world, little is known about the prevalence of diabetes in pregnancy in rural areas of East Africa. Diabetes in pregnancy has effects on prospects for marriage, motherhood, and the role of women in East African society. Furthermore, intrauterine exposure to the metabolic environment of maternal diabetes, or GDM, is associated with increased risk of altered glucose homeostasis in the offspring, beginning in childhood and producing a higher prevalence of GDM in the next generation with all burdens and complications being associated with this disease. It is reasonable to conclude that more newborn infants each year are being exposed to the metabolic environment of diabetes during intrauterine development as a result of changing incidence and demographics of diabetes and pregnancy. We believe that programs and policies have to be established, including organization of the health system to provide care, medicines, and other tools necessary for diabetes in pregnancy management, consideration of accessibility and affordability of care, education for healthcare workers, and education of pregnant and nonpregnant women of reproductive age.
Collapse
Affiliation(s)
- Willibald Zeck
- Department of Obstetrics and Gynecology, Medical University of Graz, Austria.
| | | |
Collapse
|
29
|
Simmons D. Diagnosis of gestational diabetes mellitus--a comparison of two screening tests. Which is the way ahead? NATURE CLINICAL PRACTICE. ENDOCRINOLOGY & METABOLISM 2008; 4:72-73. [PMID: 17998921 DOI: 10.1038/ncpendmet0696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 10/11/2007] [Indexed: 05/25/2023]
Affiliation(s)
- David Simmons
- Institute of Metabolic Science, Box 281, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK.
| |
Collapse
|
30
|
Zeck W, Panzitt T, Schlembach D, Lang U, McIntyre D. Management of diabetes in pregnancy: comparison of guidelines with current practice at Austrian and Australian obstetric center. Croat Med J 2008; 48:831-41. [PMID: 18074418 DOI: 10.3325/cmj.2007.6.831] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To compare Austrian and Australian national guidelines for gestational and pre-gestational diabetes and estimate the level to which physicians comply with their country's guidelines. METHODS Austrian (ODG, Austrian Diabetes Society) and Australian guidelines (ADIPS, Australasian Diabetes in Pregnancy Society) for the treatment of gestational diabetes and pre-gestational diabetes were systematically reviewed. Current practices in two obstetric centers in Austria and Australia were assessed by interviewing key stakeholders through questionnaires assessing different components of diabetes care. For gestational diabetes, these components were screening, abnormal oral glucose tolerance test values (mmol/L), abnormal values for diagnosis, further management when abnormal values are detected, monitoring/glucose targets (mmol/L), further management and indications for insulin therapy, route and timing of delivery, and postpartum management and counseling. For pre-gestational diabetes, the components were management during the preconceptional period, glucose target values, medical surveillance, obstetric surveillance, medication used, route and timing of delivery, and postpartum management and counseling. RESULTS More variation was found in the management of gestational than pre-gestational diabetes. There were differences in oral glucose tolerance test and cut-off levels for diagnosing gestational diabetes in both centers and guidelines. Australian guidelines recommended two-stage screening for gestational diabetes, while Austrian guidelines recommended one-stage screening. At the Austrian obstetric center, amniocentesis was recommended for determining the start of insulin treatment in pregnant women with gestational diabetes. This approach was neither used at the Australian obstetric center nor recommended by any of the two guidelines. CONCLUSION Our study showed that it was difficult to standardize screening criteria and diagnostic methods for gestational and pre-gestational diabetes. National and international consensus has yet to be achieved in the management of diabetes in pregnancy.
Collapse
Affiliation(s)
- Willibald Zeck
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, A-8036, Graz, Austria.
| | | | | | | | | |
Collapse
|
31
|
Simmons D, Eaton S, Shaw J, Zimmet P. Self-reported past gestational diabetes mellitus as a risk factor for abnormal glucose tolerance among Australian women. Diabetes Care 2007; 30:2293-5. [PMID: 17575090 DOI: 10.2337/dc07-0290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- David Simmons
- School of Rural Health, University of Melbourne, Shepparton, Australia.
| | | | | | | |
Collapse
|
32
|
Bibliography. Current world literature. Diabetes and the endocrine pancreas II. Curr Opin Endocrinol Diabetes Obes 2007; 14:329-57. [PMID: 17940461 DOI: 10.1097/med.0b013e3282c3a898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2007; 14:170-96. [PMID: 17940437 DOI: 10.1097/med.0b013e3280d5f7e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|