Prevalence and Risk Factors for the Development of GD in Some Eastern European Countries – Tendencies and Pharmacoeconomical Assessment for the Choice of Treatment

Abstract

Diabetes is a metabolic disorder of fat, carbohydrate, and protein metabolism, characterized by resistance to the action of insulin, insufficient insulin secretion, or both. The two major classifications of diabetes mellitus (DM) are type 1 (insulin deficient) and type 2 (combined insulin resistance and relative deficiency in insulin secretion). They differ in clinical presentation, onset, etiology, and progression of disease. Two to five percent of pregnancies are complicated by diabetes, of which 90% are classified as gestational diabetes mellitus (GD) (Satman et al, 2002). GD is defined as glucose intolerance of variable severity which is first recognized during pregnancy, including individuals with previously undiagnosed diabetes as well as those in whom high glucose levels are provoked by pregnancy. This term should not be used for gravid women with previously diagnosed diabetes. GD has much in common with type 2 diabetes with similar genetic susceptibility, corresponding prevalence within a given population or ethnic group and similar risk factors. Both conditions can be considered as a mixture of insulin resistance (IR) and impaired insulin secretion. Indeed, GD is a predictor of future type 2 diabetes with a cumulative incidence of about 50% at 5 years. GD is also a predictor of the metabolic (resistance) syndrome and should probably be considered a cardiovascular risk factor for later life. Since its first description in the early 1950s, GD has been one of the most controversial syndromes in the field of diabetes. Pregnancy is a state of insulin resistance, characterized by raised circulating insulin concentrations as the maternal pancreas compensates for increased peripheral demands. If adequate compensation does not occur, GD develops. GD is a well-established risk factor for adverse infant health outcomes, including fetal macrosomia, birth trauma, neonatal hypoglycemia, and fetal death (Cetin et al., 1997). GD can predict that the children of women who have GD are at an increased risk for obesity, glucose intolerance, and diabetes during adulthood. There is still confusion about the type of diagnostic tests and diagnostic criteria for GD and a screening protocol (e.g. universal versus selective screening). Gestational diabetes complicates about 1-14% of all pregnancies, depending on the