Control In Gestational Diabetes Mellitus Research Articles

Comparative study between the use of long-acting insulin versus multiple dose regimen in control of Gestational Diabetes Mellitus: a randomized controlled trial

Comparative study between the use of long-acting insulin versus multiple dose regimen in control of Gestational Diabetes Mellitus: a randomized controlled trial

Analysis of risk factors of neonatal hypoglycemia and its correlation with blood glucose control of gestational diabetes mellitus: A retrospective study.

This study aimed to investigate the risk factors associated with neonatal hypoglycemia and its correlation with blood glucose control in patients with gestational diabetes mellitus (GDM). This study was a retrospective study. 880 pregnant women with GDM and their newborns were hospitalized from January 2018 to December 2022 in our hospital. The clinical information of GDM pregnant women and their newborns were reviewed and the hemoglobin A1c (HbA1c) values measured within 1 week before delivery were collected. According to the occurrence of neonatal hypoglycemia, which was divided into the control and observation groups. Logistic regression model was used to estimate the potential factors associated with neonatal hypoglycemia. The association between HbA1c of pregnant women before delivery and abnormal glucose metabolism in newborns was examined using spearman correlation analysis. A total of 104 cases of hypoglycemia occurred in neonates delivered by 880 GDM women and the incidence of neonatal hypoglycemia was 11.82%. There were significant differences in pre-pregnancy overweight or obesity, delivery mode, maternal blood sugar control effect and neonatal feeding standard between the 2 groups of GDM women (P < .05). Pre-pregnancy overweight or obesity, poor blood sugar control in GDM women, and improper neonatal feeding were risk factors for neonatal hypoglycemia. The results of logistic regression analysis showed that abnormal glucose metabolism in newborn (odds ratio [OR]: 2.43, 95% confidence interval [CI]: 1.12-4.73) and neonatal hypoglycemia (OR: 3.04, 95% CI: 1.33-5.79) were a risk factor. We also conducted the logistic analysis to evaluate the correlation between HbA1c before delivery and abnormal glucose metabolism in newborns of pregnant women with GDM through adjusting some potential factors. The results were still significant in the abnormal glucose metabolism in newborn (OR: 2.84, 95% CI: 1.23-6.63) and neonatal hypoglycemia (OR: 3.64, 95% CI: 1.46-8.18). Overweight or obesity of GDM parturient before pregnancy, poor blood glucose control of GDM parturient and improper feeding of newborns are all risk factors for neonatal hypoglycemia. HbA1c before delivery has a certain predictive value for abnormal glucose metabolism in newborns.

High Free T3 Levels in the Second Trimester are Correlated with the Control of Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM) and abnormal thyroid function are two common endocrine disorders occurring during pregnancy. In this study, we evaluated the correlation between the levels of different thyroid hormones and blood glucose control in pregnant women with diet-controlled GDM. Mid-pregnancy serum samples were obtained from 439 participants with GDM controlled by diet for analyses of thyroid function. A 2-h 75-g oral glucose tolerance test was used to evaluate the effect of blood glucose controlled by diet. According to blood glucose levels before and 2h after a meal, mothers were grouped into GDM-A1 (≤5.3mmol/L, ≤6.7mmol/L, respectively) and GDM-A2 (&gt;5.3 mmol, &gt;6.7mmol/L, respectively) and these groups were compared to the associated thyroid levels using multivariate logistic regression analysis. Our results show that fT3 was positively associated with GDM-A2. The adjusted odds ratio (95% confidence interval) comparing the highest and lowest fT3 quartile was 3.12 (1.66, 15.87) at the second trimester. Neither TSH nor fT4 was significantly associated with GDM-A2. Higher FT3 levels during the second trimester of pregnancy are a risk for GDM-A2 incidence. This provides new ideas for the control of GDM.

CОВРЕМЕННЫЕ МАРКЕРЫ ГЕСТАЦИОННОГО САХАРНОГО ДИАБЕТА: ПРЕИМУЩЕСТВА И НЕДОСТАТКИ

The study aims to generalize and systematize information obtained from the literature of 10 years from the MEDLINE, PubMed, eLIBRARY.RU, and RISC databases about additional markers of glycemic control in gestational diabetes mellitus for evaluation of its effectiveness and treatment correction. The review article included 22 literature sources out of 156 analyzed publications on the issue. There is not enough research available on such markers as fructosamine, glycated albumin, and 1.5-anhydroglucitol. Therefore, it is required to study and implement them into practice further on in order to optimize the treatment and manage pregnancies with gestational diabetes mellitus.

The Harm and Prevention and Control of Gestational Diabetes Mellitus

Gestational diabetes is one of the challenges that many pregnant mothers face during this particular stage. Gestational diabetes is not only harmful to pregnant women, but also has adverse effects on offspring. Overcoming this difficulty is not so easy, expectant mothers need to control many aspects, from exercise, medication, and diet. This article analyzes the etiology and risk factors of gestational diabetes and makes recommendations based on this. The diet for gestational diabetes should be small and frequent meals, and the corresponding calorie intake should be based on one's body weight. The type of food should be less fat and easy to digest and eat more foods that have a low impact on blood sugar, such as whole grains, beans, cucumbers, and tomatoes. Patients with gestational diabetes are suitable for soothing aerobic exercise. Exercises ideal for pregnant women mainly include yoga, walking, gymnastics, etc. The time for each activity is generally 20 to 30 minutes.

METFORMIN OR INSULIN IN GESTATIONAL DIABETES-A CONUNDRUM

Objective: To determine the effectiveness of metformin vs insulin for glycemic control in gestational diabetes mellitus. Methodology: This study was done in the Department of Gynecology and Obstetrics, Saidu Teaching Hospital Swat from November 2019 to May 2020. Ethical approval was taken from the hospital ethical and research com­mittee. A sample of 93 patients in each group was taken as per WHO sample size calculation software. All female patients with singleton pregnancies having gestational diabetes diagnosed for the first time in current pregnancy with an age limit from 16-40 Years were included in this study. The lottery method was used for dividing patients into two groups, group A (Metformin) and group B (Insulin). SPSS 23.0 was used for the data analysis using fre­quencies and percentages and the Chi-Square test was used to compare the efficacy of drugs between the two study groups. Efficacy was checked by measuring 1-hour postprandial sugar levels, i-e; more or less than 140mg/ dl. A p-value less than or equal to 0.05 was considered statistically significant. Results: Total number of patients was 186 (93 in each group). The mean age in group A was 28±3.76 years compared to 27±3.13 years in group B. Good glycemic control out of our total 186 patients (93 in each group) was achieved in 80%(n-74) in Group A compared to 90% (n-84) in Group B with a p-value was 0.0403. Conclusion: The study concludes that metformin is non-inferior to insulin in controlling glucose levels in gesta­tional diabetes mellitus.

Effect of the New Nordic Diet compared with usual care on glucose control in gestational diabetes mellitus: Study protocol for the randomized controlled trial intervention with new Nordic DIet in women with GestatiOnal diabetes mellitus (iNDIGO)

BackgroundGestational diabetes mellitus (GDM) is a pregnancy complication associated with short- and long-term health consequences for mother and child. First line treatment is diet and exercise but there is a recognized knowledge gap as to what diet treatment is optimal. A healthy Nordic diet has been associated with improved health but no studies in women with GDM exist. The New Nordic Diet (NND) is an initiative with the purpose to develop a healthy Nordic diet including foods with the potential to grow in Nordic countries; including fruit, berries, vegetables, whole-grain cereal products, nuts, fish, and rapeseed oil. The purpose of the intervention with new Nordic DIet in women with GestatiOnal diabetes mellitus (iNDIGO) is to test if the NND compared with usual care improves glucose control in women with GDM. MethodsThe iNDIGO study is a randomized parallel controlled trial where 50 women with GDM will be randomized to either an NND or usual care for 14 days (30–32 weeks of gestation). Participants in the NND group will receive menus and food bags containing foods to be consumed. Primary outcome is glycemic control (time in target) measured using continuous glucose monitoring. Compliance to the dietary intervention will be tested using dietary biomarkers and adherence questionnaires. ConclusionDiet treatment represents first line treatment in GDM but it remains unclear what type of diets are effective. iNDIGO is an efficacy study and will provide evidence as to whether a healthy Nordic diet can improve glucose control in women with GDM.Trial registration: ClinicalTrials.gov registration Number: NCT04169243. Registered 19 November 2019, https://clinicaltrials.gov/ct2/show/NCT04169243.

Metformin versus glyburide in treatment and control of gestational diabetes mellitus: a systematic review with meta-analysis.

ABSTRACTObjective To compare the major outcomes of use of metformin and glyburide in treatment of gestational diabetes mellitus.Methods Studies published in English, in the last 10 years, in the databases MEDLINE®, SciELO, LILACS and Cochrane Library were analyzed, and randomized controlled trials were selected. Health Sciences Descriptors were used to compose the search phrase, and the keywords “Gestational diabetes”, “Glyburide”, “Metformin” and their variations were searched in the Medical Subject Headings. PRISMA systematization was used to prepare this review, and a meta-analysis was conducted aiming to mathematically show the results of fasting blood glucose, postprandial blood glucose, birth weight and weight gain during pregnancy after using metformin and glyburide.Results The studies evaluated birth weight, neonatal hypoglycemia, mode of delivery, need for intensive care, Apgar score, macrosomia, fasting glucose, postprandial glucose and weight gain during pregnancy. In 60% of studies, there were no statistically significant differences regarding safety and efficacy of administration of metformin and glyburide. Meta-analysis demonstrated the absence of statistical differences between these drugs in fasting blood glucose (p=0.821), postprandial blood glucose (p=0.217) and birth weight (p=0.194). However, significant differences were shown in weight gain during pregnancy (p=0.036).Conclusion The methods are effective, but the adverse effects of glyburide are more common; therefore, the use of metformin should be recommended, if in monotherapy.

Metformin action over gut microbiota is related to weight and glycemic control in gestational diabetes mellitus: A randomized trial.

Metformin, which is known to produce profound changes in gut microbiota, is being increasingly used in gestational diabetes mellitus (GDM). The aim of this study was to elucidate the differences in gut microbiota composition and function in women with GDM treated with metformin compared to those treated with insulin. From May to December 2018, 58 women with GDM were randomized to receive insulin (INS; n=28) or metformin (MET; n=30) at the University Hospital Virgen de la Victoria, Málaga, Spain. Basal visits, with at least 1 follow-up visit and prepartum visit, were performed. At the basal and prepartum visits, blood and stool samples were collected. The gut microbiota profile was determined through 16S rRNA analysis. Compared to INS, women on MET presented a lower mean postprandial glycemia and a lower increase in weight and body mass index (BMI). Firmicutes and Peptostreptococcaceae abundance declined, while Proteobacteria and Enterobacteriaceae abundance increased in the MET group. We found inverse correlations between changes in the abundance of Proteobacteria and mean postprandial glycemia (p=0.023), as well as between Enterobacteriaceae and a rise in BMI and weight gain (p=0.031 and p=0.036, respectively). Regarding the metabolic profile of gut microbiota, predicted metabolic pathways related to propionate degradation and ubiquinol biosynthesis predominated in the MET group. Metformin in GDM affects the composition and metabolic profile of gut microbiota. These changes could mediate, at least in part, its clinical effects. Studies designed to assess how these changes influence metabolic control during and after pregnancy are necessary.

Effect of Community Nursing Intervention on Postpartum Blood Glucose and Weight Control of Gestational Diabetes Mellitus

Effect of Community Nursing Intervention on Postpartum Blood Glucose and Weight Control of Gestational Diabetes Mellitus

Continuous Glucose Monitoring in Women with Normal OGTT in Pregnancy.

Continuous glucose monitoring (CGM) might be an effective tool to improve glycemic control in gestational diabetes mellitus (GDM). Few data are available about its utilization as a diagnostic tool to find potential alterations of glycemia in subjects with normal oral glucose tolerance test (OGTT). In this preliminary prospective real-life observational study, we aimed to analyze the glycemic pattern in normal and gestational diabetes mellitus (GDM) women by continuous glucose monitoring (CGM) in order to detect potential differences between the two groups and glycemic alterations despite a normal OGTT. After the screening for GDM, subjects were connected to a CGM system for seven consecutive days. The areas under the curve of the first 60 minutes after each meal and 60 minutes before breakfast were analyzed. Women with normal OGTT that during CGM showed impaired glycemic values (more than 95 fasting or more than 140 one hour after meals or more than 120 two hours after meals) performed one week of self-monitoring of blood glucose (SMBG). After OGTT, 53 women considered normal and 46 affected by GDM were included. CGM parameters did not show any differences between the two groups with impaired glycemic excursions found in both groups. After CGM period, 33 women with normal OGTT showed abnormal glycemic patterns. These 33 women then performed one week of SMBG. After evaluation of one week of SMBG, 21 required diet therapy and 12 required insulin treatment and were followed until the delivery. An increase in gestational weight gain was observed in normal women with normal OGTT but this was not significant. No significant data were found regarding neonatal outcomes in the two groups of women. In conclusion, CGM use in pregnancy might help to detect glycemic fluctuations in women with normal OGTT, improving their treatment and outcomes.

The Influence of Sleep on Glycated Hemoglobin in Pregnancy With Gestational Diabetes

Background: Sleep disturbances have been associated with poor glycemic control in differential clinical settings. Both short and long sleep duration, influence insulin resistance and blood glucose in diabetic patients. Pregnancy is an additional risk for reduced sleep quality and quantity, and the presence of hyperglycemia, as a complicating factor, has being increasingly frequent. Different measures of sleep evaluation, both objectively and subjectively, can provide additional information about the influence of sleep in metabolic control in Gestational Diabetes Mellitus (GDM). Objective: To investigate the influence of sleep quality and objective sleep measures on glycated hemoglobin (HBA1C) in patients with GDM. Methodology: This is a cross-sectional study examining patients with GDM from 2nd to 3rd trimester of pregnancy. Clinical data and behavior questionnaires were collected by a face-to-face interview. Self-Rated Sleep Quality was evaluated by Pittsburgh Sleep Quality Index- (PSQI). In order to improve the accuracy of the information, a 14-day sleep log was obtained, and objective sleep measurements were registered by actigraphic record (5 to 7 days). Results: Overall, GDM patients (N=311), aged from 20 to 46 y (33.1±5.6) were evaluated. Sleep duration ≤6 hours/night was found in 43.4%, and 63.9% reported poor sleep quality (PSQI>5). Sleep duration measured by actigraphy was correlated with sleep duration registered by sleep log (r=.45, p=.04), and with PSQI (r=-.33, p=.002). Sleep quality and sleep duration registered by either actigraphy or sleep log were not correlated with Hba1c. Amongst all, Hba1c varied from 4.3 to 7.0 mg/dL (5.9 ±.53). Sleep fragmentation, measured by the length of time patient spends awake after sleep onset (WASO) was correlated withHba1c level in patients with GDM (r=.41, p=0.04). Conclusion: Sleep duration obtained from the sleep log was a reliable measure correlating with objective sleep parameters registered by actigraphy and with sleep quality. In GDM patients, increased wake time after sleep onset was correlated with higher Hba1c.

Physical Activity Programs during Pregnancy Are Effective for the Control of Gestational Diabetes Mellitus.

Gestational diabetes mellitus has an incidence of 14% worldwide and nursing is responsible for its monitoring during pregnancy. Excessive weight gain during pregnancy is directly related to gestational diabetes mellitus development. Gestational diabetes mellitus (GDM) has negative repercussions on the evolution of the pregnancy and the fetus. The objective of this systematic review is to establish how physical activity influences pregnant women with gestational diabetes mellitus and to analyze what benefits physical activity has in the control of gestational diabetes mellitus. A systematic search was carried out in different databases (Cochrane, Superior Council of Scientific Investigations (CSIC), EBSCOhost, Pubmed, Scopus, Web os Science, and Proquest) for papers published within the last 12 years, taking into account different inclusion and exclusion criteria. Six randomized controlled studies and one observational case-control study of a high quality were selected. Fasting, postprandial glucose and HbcA1 were assessed, as well as the requirement and amount of insulin used. Thus, there is a positive relationship between the performance of physical activity and the control of gestational diabetes mellitus. Resistance, aerobic exercise, or a combination of both are effective for the control of glucose, HbcA1, and insulin. Due to the variability of the exercises of the analyzed studies and the variability of the shape of the different pregnant women, it does not permit the recommendation of a particular type of exercise. However, any type of physical activity of sufficient intensity and duration can have benefits for pregnant women with GDM. Pregnant women with gestational diabetes mellitus should exercise for at least 20–50 min a minimum of 2 times a week with at a least moderate intensity.

Metformin as a Safe Option to Insulin in Gestational Diabetes Mellitus: a Retrospective Study

When pharmacological treatment is needed to reach control of gestational diabetes mellitus (GDM), insulin is still first-line agent but metformin has been progressively pointed as an effective alternative. Our aim is to confirm whether metformin is an effective and safe option to insulin, by comparing maternal and foetal outcomes between women with GDM treated with these drugs. Retrospective study including 399 women with GDM, 135 needing pharmacological treatment. Comparison of demographic features, risk factors for GDM, maternal and foetal outcomes between women treated with insulin (G1, 41/135) and those treated with metformin (G2, 94/135). X2/Fisher tests were performed. Significance was set at p < 0.05. Both groups showed similar features and risk factors for GDM, except for chronic hypertension, more prevalent in G1. Therapy with insulin showed poorer metabolic control with higher rate of pregnant with HbA1c ≥ 6% (42 mmol/mol) (25.6 vs 4.5%, p = 0.001) and more polihydramnios (14.6% vs 3.2%, p = 0.023). A higher rate of caesarean was observed in G1, however, with no statistical difference (42.5% vs 26.9%, p = 0.076). There were more newborns weighing < 2500 g in women treated with metformin. No other outcome showed difference with statistical significance, namely maternal weight gain, macrosomia or neonatal comorbidities. Metformin allowed a good metabolic control with maternal and foetal outcomes similar to insulin. Metformin has proven effective as a pharmacological option to insulin. Prospective and randomized studies are needed as well as evaluation of long term benefits of metformin.

Gestational Diabetes Mellitus and Pandemic Covid-19: Where do we Stand?

Pregnant women with increasing blood glucose levels are identified as being more exposed to the severe effects of COVID-19 and advised to follow social distancing stringently. The COVID-19 pandemic has required rapid transformation and adaptation of healthcare services. Timely screening for hyperglycaemia in pregnancy using a simple glucose test still enhances early detection and control of gestational diabetes mellitus (GDM).

Role of metabolic glycemic control in programming perinatal risk in gestational diabetes

Purpose. Evaluate the effect of metabolic control of gestational diabetes mellitus (GDM) on the perinatal period course and anthropometric parameters of newborns.Materials and methods. 300 newborns were divided into 4 groups depending on the metabolic control of the mother. Group 1: fasting glycemia &lt;5.1 mmol/L, 1 hour after meals &lt;7.0 mmol/L (n = 50); Group 2: &lt;5.3 mmol/L and &lt;7.8 mmol/L (n = 90); Group 3: &gt; 5.3 mmol/L and&gt; 7.8 mmol/L (n = 46), respectively; Group 4: control (n = 114). The analysis of the perinatal period course was carried out, the anthropometric parameters were estimated according to the tables INTERGROWTH-21st.Results. Differences in the frequency of obstetric injuries, which risk is associated with «above average» body weight of the newborn (p = 0.04), were found between the GDM group and the control group (38.7 and 12.3%, respectively, p = 0.0000005). The risk of having a baby with «above average» body weight (Group 1/Group 4, OR = 1.9, p = 0.1; Gr. 2/Gr. 4, OR = 2.6, and Gr. 3/Gr. 4, OR = 3.7, p &lt;0.05), the ratio of weight/length (Gr. 1/Gr. 4, OR = 0.9, p = 0.9; Gr. 2/Gr. 4, OR = 3.6, and Gr. 3/Gr. 4, OR = 4.9, p &lt;0.05) and head circumference (G.1/Gr. 4, OR = 1.1, p = 0.6; Gr. 2/Gr. 4, OR = 2.5, and Gr. 3/Gr. 4, OR = 2.9, p &lt;0.05) was higher in Groups 2 and 3 than in Group 4. In the early neonatal period with GDM, hypoglycemia was more common than in the control Group 4. The lowest risk was in Group 1 (Gr. 1/Gr. 4, OR = 4.8; Gr. 2/Gr. 4, OR = 6.7; Gr. 3/Gr. 4, OR = 7.9, р &lt; 0,05).Conclusions. Group 1 showed the lowest frequency and risk of adverse effects, which meets the control criteria of the Russian consensus.

Intensive glycemic control in gestational diabetes mellitus: a randomized controlled clinical feasibility trial

Overweight and obese women with gestational diabetes mellitus are at increased risk for adverse perinatal outcomes, and they are also more likely to have suboptimal glycemic control. However, there is a paucity of data evaluating whether lower glycemic targets could improve outcomes. To evaluate the feasibility of intensive glycemic control in overweight and obese women with gestational diabetes mellitus. We randomized 60 overweight or obese women with gestational diabetes mellitus, diagnosed between 12 and 32 weeks' gestation to either intensive (fasting <90 mg/dL, 1 hour postprandial <120 mg/dL) or standard (fasting <95 mg/dL, 1 ho postprandial <140 mg/dL) glycemic targets. Maternal glucose was assessed in 2 ways: blinded continuous glucose monitors, worn for 5 days at 2 time points (at 12-32 weeks and again at 32-36 weeks), and self-monitored glucose measurement 4 times per day. All women underwent standardized dietary counseling, and medical therapy was prescribed as needed to achieve glycemic control. Between December 2015 and December 2017, we randomized 60 women to either intensive (n= 30) or standard (n= 30) glycemic control. Baseline characteristics including maternal age, body mass index, and gestational age at diagnosis were similar between the intensive and standard groups. Medical therapy was more common in women in the intensive group than those in the standard group (83 vs 57%, P= .02). Women in the intensive glycemic control group had lower glucose values as assessed by continuous glucose monitors at including 24-hour mean (-8.1; 95% confidence interval,-12.0 to-4.3 mg/dL; P< .0001) and 1-h postprandial (-11.8; 95% confidence interval,-19.7 to-3.9 mg/dL, P= .004) values. Hypoglycemia <60 mg/dL was uncommon and did not differ between groups. Intensive glycemic targets can be used in overweight and obese women with minimal hypoglycemia, and this approach results in improved glycemic control when compared to standard glycemic targets. Further studies are needed to determine whether intensive glycemic targets can improve maternal and neonatal outcomes in high-risk women with gestational diabetes mellitus. NCT02530866; clinicaltrials.gov.

Good glycemic control of gestational diabetes mellitus is associated with the attenuation of future maternal cardiovascular risk: a retrospective cohort study

BackgroundTo examine whether glycemic control of gestational diabetes mellitus (GDM) could modify the risk for future maternal metabolic and cardiovascular morbidities.MethodsA retrospective cohort study of women with a first diagnosis of GDM who delivered between 1991 and 2011. Women were divided into groups of good and poor glycemic control, defined as a mean daily glucose of up to 95 mg/dL (N = 230) and more than 95 mg/dL (N = 216), respectively. In addition, a control group of women without GDM (N = 352) was also analyzed. The primary outcomes were the development of type 2 diabetes mellitus (T2DM), obesity, hypertension, or dyslipidemia.ResultsMean follow-up time was 15.8 ± 5.1 years. Assessment was performed at a maternal age of 45 ± 7 years. The rates of the study outcomes in the control, GDM with good glycemic control and GDM with poor glycemic control were as follows: T2DM [19 (5.4%), 87 (38%), 127 (57%)]; hypertension [44 (13%), 42 (18%), 44 (20%)]; obesity [111 (32%), 112 (48%), 129 (58%)]; and dyslipidemia [49 (14%), 67 (29%), 106 (48%)]. Glycemic control was an independent risk factor for T2DM in multivariate Cox regression analysis (hazard ratio (HR) for poor glycemic control vs. controls 10.7 95% CI [6.0–19.0], good glycemic control vs. control HR 6.0 [3.3–10.8], and poor glycemic control vs. good glycemic control HR 1.8 [1.3–2.4]). Glycemic control was also an independent risk factor for dyslipidemia (poor glycemic control vs. controls HR 3.7 [2.3–5.8], good glycemic control vs. controls HR 2.0 [1.2–3.2], and poor glycemic control vs. good glycemic control HR 1.8 1.8 [1.3–2.6]). The fasting glucose level during oral glucose tolerance test (OGTT) was also an independent risk factor for these complications. The interaction term between glycemic control and the fasting value of the OGTT was not statistically significant, suggesting that the effect of glycemic control on the rate of future T2DM and dyslipidemia was not modified by the baseline severity of GDM.ConclusionGDM and especially poor glycemic control are associated with T2DM and dyslipidemia. Strict glycemic control for reducing that risk should be evaluated in prospective trials.

88: Intensive glycemic control in gestational diabetes mellitus: a randomized controlled clinical trial

88: Intensive glycemic control in gestational diabetes mellitus: a randomized controlled clinical trial

Cost-effectiveness of controlling gestational diabetes mellitus: a systematic review

ObjectiveTimely screening for hyperglycaemia in pregnancy using a simple glucose test enhances early detection and control of gestational diabetes mellitus (GDM). The aim of this study was to provide an overview of the evidence on the cost-effectiveness of identification and/or treatment of GDM.MethodsWe conducted a systematic review using three electronic databases (PubMed, EMBASE, and Cochrane) of cost-effectiveness studies of GDM screening and treatment published during 2000–2017.ResultsThe initial search discovered 287 references (PubMed 86, EMBASE 195, Cochrane library 6) of which six full articles were included in the review. Two articles were model-based analysis and the remaining four were trial based. Two studies demonstrated favorable cost-effectiveness of intensified management of mild GDM. In the other included studies, neither screening nor treatment of GDM was shown to be cost effective, although results varied with the particular outcome measures used and the assumptions that where applied.ConclusionNeither screening nor treating GDM seems to be convincingly cost-effective from the studies reviewed. However, all studies were done in high-income countries with obviously different health systems than low-/middle-income countries (LMIC) have. Since detection of GDM may be relatively poor in LMIC, screening might be more worthwhile in these countries. Comprehensive research is necessary in LMIC, including the potential outcomes of assessing its cost-effectiveness. Favorable cost-effectiveness could help in bridging the need for and access to increased diabetes screening in early pregnancy in these countries.