Management Of GDM Research Articles

How Important Is Early Diagnosis and Intense Insulin Therapy in In Vitro Fertilization Pregnancies Complicated by Gestational Diabetes Mellitus?

GDM is increased in IVF pregnancies. There is limited literature on GDM screening and management of IVF pregnancies. The aim was to investigate the impact of GDM management on the outcome of IVF pregnancies. The study was conducted with 102 singleton IVF (a), 102 GDM spontaneous conceptions (b) vs. 102 normal pregnancies (c). The group characteristics: [age: 38.2±4 vs. 34.1±3 vs. 37.4±5 years, p<0.001 (a vs. b), NS (a vs. c), <0.001 (b vs. c); BMI: 25.8±5 vs. 23±4 vs. 22.7±4 kg/m2, p<0.001 (a vs. b), <0.001 (a vs. c), NS (b vs. c); HbA1c: 5.2±0.5 vs. 5.2±0.7 vs. 4.7±0.3%, p=NS (a vs. b), <0.001 (a vs. c), <0.001 (b vs. c); FBG: 84.1±8.4 vs. 84.2±7.1 vs. 78.2±5.2 mg/dl, p=NS (a vs. b), <0.001 (a vs. c), <0.001 (b vs. c); 1-hour postprandial BG: 103.6±11 vs. 106.5±10 mg/dl, p=NS (a vs. b); week of diagnosis GDM: 21.8±5.2 vs. 23.8±6.2, p=0.03 (a vs. b); week of starting insulin: 22.8±5 vs. 24.8±5, p=0.03 (a vs. b)].The obstetric and neonatal history are: Maternal weight gain: 10.4±4 vs. 11.9±3 vs. 10.5±2kg, p=0.035 (a vs. b), p=NS (a vs. c), p=0.03 (b vs. c); week. of delivery: 36.9±2 vs. 37.4±0.7 vs. 38.1±0.8, p=0.04 (a vs. b), p<0.001 (a vs. c), p<0.001 (b vs. c); neonatal birth wt.: 2857±517 vs. 2891±341 vs. 3117±347g, p=NS (a vs. b), p<0.001 (a vs. c), p<0.001 (b vs. c); preeclampsia rate: 4.9 vs. 3.9 vs. 1.9%; Respiratory Distress Syndrome: 14.7 vs. 12 vs. 5.8%; Neonatal hypoglycemia: 17.6 vs. 14.7 vs. 3.9%, NICU admits: 14.7 vs. 15.6 vs. 5.8%, C-Section: 86.3 vs. 56.9 vs. 41.1%. Associations between characteristics and adverse outcomes were tested among the IVF group. 1-hour Postprandial BG, but not FBG nor HbA1c, was associated with maternal-fetal complications (r=0.504, p<0.001). Maternal hypoglycemia did not affect fetal outcome. Age and BMI were not correlated with the week of GDM diagnosis. The data emphasizes the importance of strict postprandial metabolic control reached by intense early insulin therapy limiting the incidence of adverse pregnancy outcomes. IVF pregnancies must be screened for GDM much earlier than 24-28 weeks. Disclosure P. Thomakos: None. O. Kepaptsoglou: None. A. Trouva: None. C. Baretto: None. D. Trouvas: None. I. Taraoune: None. A. Korantzis: None. C. Zoupas: None.

Comparison of Cardiometabolic Risk Factors in Offspring of Diabetic Mothers (ODM) and Nondiabetic Mothers (ONDM) in India

Background: Maternal diabetes is a risk factor for obesity and glucose intolerance in the child, and contributes to the escalating epidemic of diabesity. This could have both a genetic and fetal programming basis. Only sparse data is available in India. We followed children born to diabetic and nondiabetic mothers 2-26 years after delivery to assess their cardio-metabolic risk factors. Methods: Of 861 women diagnosed and treated for diabetes in pregnancy (1986-2014), we traced 346 and studied 200 children (ODM). We also studied 177 children of nondiabetic mothers (ONDM), matched for age, gender and socioeconomic status. We measured anthropometry, body composition (DXA) and a capillary blood glucose (<10y, 119 ODM, 93 ONDM) or a 1.75g/kg OGTT with venous blood (>10y, 81 ODM, 84 ONDM). Overweight+obesity was diagnosed by IOTF (≤18y) or WHO criteria (>18y). Glucose tolerance was classified by the ADA 2014 criteria. We compared cardio-metabolic risk factors in ODM and ONDM by calculating age and gender specific SD scores (reference ONDM). Results: Three (4%) ODM were known diabetic (diagnosed at 16, 14 and 23y, 2 receiving OHA and 1 insulin), one was diagnosed on testing. ODM had higher BMI, skinfolds, body fat percent, and circulating glucose, insulin, total and LDL cholesterol, and triglyceride concentrations. ODM had higher HOMA-IR and pulse rate but lower disposition index (HOMA-β/HOMA-IR) and diastolic blood pressure. Prediabetes (IFG+IGT) (37 vs. 20%, p=0.005) and overweight+obesity (24 vs. 15%, p=0.014) were more common in ODM compared to ONDM. Conclusions: We confirm elevated risk of obesity, adiposity, diabetes and other cardio-metabolic risk factors in children of Indian diabetic mothers. Despite following the current standards of practice for GDM management, the offspring continue to have high risk of diabesity. This suggests a need for reevaluation of current standards of care which overlook the peri-conceptional window of fetal programming. Disclosure S.S. Wagle: None. K. Kumaran: None. R. Ladkat: None. D. Bhat: None. P.C. Yajnik: None. C.S. Yajnik: None.

Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa \u2013 a qualitative study

BackgroundWomen with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there is little knowledge of actual current practice. The aim of this study was to explore current policies and clinical practices relating to antenatal and post-natal care for women with GDM in South Africa, as well as health sector stakeholders’ perspectives on the barriers to -- and opportunities for -- delivering an integrated mother - baby health service that extends beyond the first week post-partum, to the infant’s first year of life.MethodsFollowing a document review of policy and clinical practice guidelines, in-depth interviews were conducted with 11 key informants who were key policy makers, health service managers and clinicians working in the public health services in South Africa’s two major cities (Johannesburg and Cape Town). Data were analysed using qualitative content analysis procedures.ResultsThe document review and interviews established that it is policy that health services adhere to international guidelines for GDM diagnosis and management, in addition to locally developed guidelines and protocols for clinical practice. All key informants confirmed that lack of postpartum follow-up for GDM women is a significant problem. Health systems barriers include fragmentation of care and the absence of standardised postnatal care for post-GDM women. Key informants also raised patient - related challenges including lack of perceived future risk of developing type 2 diabetes and non-attendance for postpartum follow up, as barriers to postnatal care for GDM women. All participants supported integrated primary health services but cautioned against overloading health workers.ConclusionAlthough there is alignment between international guidelines, local policy and reported clinical practice in the management of GDM, there is a gap in continuation of care in the postpartum period. Health systems interventions that support and facilitate active follow-up for women with prior GDM are needed if high rates of progression to type 2 diabetes are to be avoided.

Timing of diagnosis of gestational diabetes and pregnancy outcomes: A retrospective cohort.

Recent guidelines suggest screening high-risk women in early pregnancy for gestational diabetes (GDM); however, there is little evidence to support this. To compare pregnancy outcomes associated with diabetes for women with risk factors for GDM according to gestation of diagnosis. Early GDM was defined as a positive test before 20weeks gestation, late GDM as a positive test at 20 or more weeks and no GDM when both tests were negative. Retrospective analysis in an Australian tertiary hospital of women who underwent a glucose tolerance test in pregnancy prior to 20weeks gestation, and a repeat test after 20weeks gestation if the initial test was negative. Results were adjusted for maternal demographics. Women with early GDM (n=170) were no more likely to experience the obstetric composite outcome than women with late GDM (n=171) or no GDM (n=547) (early odds ratio (OR) 1.16, 95%CI 0.79-1.71; late OR 0.78, 95%CI 0.53-1.12). Infants of women with early GDM, but not late GDM, were more likely (early OR 1.8, 95%CI 1.15-2.92; late OR 1.4, 95%CI 0.90-2.23) to have the neonatal composite outcome than infants of women without GDM, predominantly due to an increase in neonatal hypoglycaemia. This result may be due to careful management of GDM, or because, after adjustment for maternal demographics, the early diagnosis of GDM does not substantially increase rates of adverse outcomes compared to GDM diagnosed in later pregnancy or no GDM in women with risk factors for GDM.

Healthcare Experiences of Low-Income Women with Prior Gestational Diabetes

Introduction An important yet understudied component of postpartum type 2 diabetes risk reduction among high risk women is experiences with the healthcare system. Our objective was to describe the healthcare experiences of a diverse, low-income sample of women with prior GDM, including their suggestions for improving care. Methods Focus groups were conducted among African American, Hispanic, and Appalachian women who were diagnosed with GDM within the past 10years. Participants were recruited from community and medical resources. Twelve focus groups were conducted, four within each race-ethnic group. Results Three broad themes were identified around barriers to GDM care, management, and follow-up: (1) communication issues; (2) personal and environmental barriers; and (3) type and quality of healthcare. Many women felt communication with their provider could be improved, including more education on the severity of GDM, streamlining information to be less overwhelming, and providing additional support through referrals to community resources. Although women expressed interest in receiving more actionable advice for managing GDM during pregnancy and for preventing type 2 diabetes postpartum, few women reported changing behaviors. Barriers to behavior change were related to cost, transportation, and competing demands. Several opportunities for improved care were elucidated. Discussion Our findings suggest that across all racial and ethnic representations in our sample, low-income women with GDM experience similar communication, personal, and environmental barriers related to the healthcare they receive for their GDM. Considering the increased exposure to the health care system during a GDM-affected pregnancy, there are opportunities to address barriers among women with GDM across different race-ethnic groups.

Medical Management of Gestational Diabetes

Gestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. The prevalence of GDM is on the rise due to increasing trends of obesity in females of child bearing age as well as due to increasing maternal age. Women at higher risk should be routinely screened of the condition and offered appropriate management in order to avoid fetal and maternal complications. GDM is associated with higher incidence of maternal and fetal complications during pregnancy and labour. There is a significant relationship between GDM and prediabetic states as well as high risk of developing type 2 diabetes mellitus. The aim of management is to keep glycaemic levels within specific targets to avoid adverse outcomes. Improved health related quality of life has been linked with treatment of gestational diabetes with active lifestyle, glucose monitoring and use of insulin. Historically, non pharmacological intervention and insulin have been the main approaches in management of GDM, though recently there is an emerging evidence of use of oral hypoglycemic agents. In this article we have reviewed the existing evidence and recommendations in management of GDM.

First trimester serum biomarkers to predict gestational diabetes in a high-risk cohort: Striving for clinically useful thresholds

ObjectivesScreening and diagnosis of gestational diabetes (GDM) has been a source of controversy. The prevalence has increased in line with an obesity epidemic and a trend towards delayed child-bearing. Treatment of even modest glycaemic impairment in pregnancy has been shown to be beneficial in preventing its clinical sequalae. However the cumbersome nature and timing of the oral glucose tolerance test coupled with debate around universal versus risk factor based screening have been problematic. This group aimed to investigate a panel of biomarkers which have shown promise in the literature to predict GDM from the first trimester in a group of high risk women. MethodsSerum samples were drawn on 248 women deemed at risk of GDM before 15 weeks’ gestation to measure C-reactive protein, sex hormone binding globulin, adiponectin and 1,5 anhydroglucitol. Patients underwent an oral glucose tolerance test as per IADPSG criteria at 28 weeks’ gestation. Multiple logistic regression was used to examine the link between incidence of GDM and early pregnancy serum biomarkers. ResultsAdiponectin levels in the first trimester are independently linked to the risk of GDM. Serum adiponectin <8.9 μg/ml gives an odds ratio of 3.3 for GDM.Mean 1,5 AG levels are significantly lower in those that go on to develop GDM. SHBG levels measured in the first trimester were linked to the risk of GDM. However, this was no longer statistically significant once BMI, ethnicity and family history were taken into consideration. First trimester measurement of CRP is not a useful indicator of GDM risk. ConclusionsFirst trimester measurement of Adiponectin and 1,5 Anhydroglucitol are potential early biomarkers for the later onset of GDM. Risk stratification using these biomarkers may facilitate early diagnosis and management of GDM to mitigate against its complications.

Improving detection and initial management of gestational diabetes through the primary level of care in Morocco: protocol for a cluster randomized controlled trial

BackgroundMorocco is facing a growing prevalence of diabetes and according to latest figures of the World Health Organization, already 12.4% of the population are affected. A similar prevalence has been reported for gestational diabetes (GDM) and although it is not yet high on the national agenda, immediate and long-term complications threaten the health of mothers and future generations. A situational analysis on GDM conducted in 2015 revealed difficulties in access to screening and delays in receiving appropriate care. This implementation study has as objective to evaluate a decentralized GDM detection and management approach through the primary level of care and assess its potential for scaling up.MethodsWe will conduct a hybrid effectiveness-implementation research using a cluster randomized controlled trial design in two districts of Morocco. Using the health center as unit of randomization we randomly selected 20 health centers with 10 serving as intervention and 10 as control facilities. In the intervention arm, providers will screen pregnant women attending antenatal care for GDM by capillary glucose testing during antenatal care. Women tested positive will receive nutritional counselling and will be followed up through the health center. In the control facilities, screening and initial management of GDM will follow standard practice. Primary outcome will be birthweight with weight gain during pregnancy, average glucose levels and pregnancy outcomes including mode of delivery, presence or absence of obstetric or newborn complications and the prevalence of GDM at health center level as secondary outcomes. Furthermore we will assess the quality of life /care experienced by the women in both arms. Qualitative methods will be applied to evaluate the feasibility of the intervention at primary level and its adoption by the health care providers.DiscussionIn Morocco, gestational diabetes screening and its initial management is fragmented and coupled with difficulties in access and treatment delays. Implementation of a strategy that enables detection, management and follow-up of affected women at primary health care level is expected to positively impact on access to care and medical outcomes.Trial registrationThe trial has been registered on clininicaltrials.gov; identifier NCT02979756; retrospectively registered 22 November 2016.

FACTORES DE RIESGO PREDICTORES DE LA NECESIDAD DEL USO DE INSULINA EN PACIENTES CON DIABETES GESTACIONAL

Introducción: la diabetes gestacional (DMG) es la alteración de la tolerancia a la glucosa que comienza o es reconocida por primera vez durante el embarazo en curso.Un mal control glucémico aumenta el riesgo de complicaciones materno-fetales severas, por lo cual el manejo estricto de la DMG es primordial para prevenirlas.La elección del tratamiento con plan nutricional o insulina depende fundamentalmente de los objetivos glucémicos alcanzados, y reconocer los factores de riesgo predictores de su fracaso permite optimizar este manejo.Objetivos: determinar los factores de riesgo predictores de la necesidad del uso de insulina en DMG.

Acceptability of Virtual Prenatal Visits for Women with Gestational Diabetes

IntroductionGestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. Current approaches to GDM management and education are labor intensive and costly. Telemedicine offers a potential solution to reduce the time and cost burden of prenatal care for women with GDM. MethodsWe assessed the acceptability of a telemedicine intervention to transmit patients’ weight, blood pressure, and blood glucose measurements from wireless devices to health care providers, and to alternate “virtual office visits” with office-based prenatal visits. We administered surveys to 70 Kaiser Permanente Southern California members with GDM to assess preferences for modalities of GDM care delivery and to understand perceptions of telemedicine. We subsequently conducted 10 qualitative interviews among women with GDM to elicit perceptions about confidence and comfort with receiving care telephonically and safety concerns. Data were coded and categorized using analytic induction. ResultsTraining on these devices would increase participants’ confidence in using the equipment. Continuity of care was perceived as an important factor in facilitating confidence with near universal preference for having virtual visits with the same clinician. Most participants were not concerned with the safety of their baby or themselves during the weeks without an office visit. One participant expressed an unwillingness to participate in the intervention because of a perceived association between having a high-risk pregnancy and an increased risk of pregnancy loss. ConclusionsAs telemedicine becomes increasingly common in health care, feedback from end users will be essential in tailoring, communicating about, and supporting the uptake and success of such programs.

Scientific Evidence for Different Options for GDM Screening and Management: Controversies and Review of the Literature.

Background. Gestational diabetes (GDM) affects up to 7% of pregnant women and is associated with several maternal and perinatal morbidities. International organizations suggest several different recommendations regarding how to screen and to manage GDM. Objective. We aimed to analyze the most important and employed guidelines about screening and management of GDM and we investigated existing related literature. Results. We found several different criteria for screening for GDM, for monitoring GDM, and for starting pharmacological therapy. When using IADPSG criteria, GDM rate increased, perinatal outcomes improved, and screening became cost-effective. Compared to no treatment, treatment of women meeting criteria for GDM by IADPSG criteria but not by other less strict criteria has limited evidence for an effect on adverse pregnancy outcomes.

"Why screen if we cannot follow-up and manage?" Challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey.

BackgroundThe prevalence of gestational diabetes (GDM) in low and lower middle income countries (LLMIC) is increasing. Despite its associated short and long term complications for mothers and their newborns, there is a lack of knowledge about how to detect and manage GDM. The objective of our study was to identify the challenges that first line healthcare providers in LLMIC face in screening and management of GDM.MethodsWe conducted a cross-sectional survey of key informants from 40 low and lower-middle income countries in Africa, South-Asia and Latin-America by sending out questionnaires to 182 gynecologists, endocrinologists and medical doctors. Sixty-seven respondents from 26 LLMIC provided information on the challenges they encounter. Data was thematically analyzed and revealed eight overarching themes, including guidelines; human resources; access; costs; availability of services, equipment and drugs; patient and community factors; and collaboration and communication.ResultsUnavailability of guidelines combined with lack of knowledge about GDM on the part of both providers and patients poses a substantial barrier to detection and management of GDM, leading to deficiencies in screening and counseling. Limited access to regular monitoring and follow-up care as a result of distance and costs, in particular with respect to additional expenses related to specific tests and changes in diet were identified as important challenges. Services were not available at all levels nor was adequate testing equipment. Patient factors included lack of motivation and compliance with the recommended therapy. Respondents also highlighted the lack of communication and collaboration between different specialists and treatment delays as a result of patients being seen by multiple providers.ConclusionsProviders from LLMIC face various challenges related to screening and managing GDM. Policy makers need to address these challenges by strengthening their health care system as a whole and by assuring that non-communicable diseases are better integrated into the existing packages of free or subsidized maternal health care.

Maternal and Foetal Outcomes of Gestational Diabetes Mothers Treated with Human Insulin

Background: The most common adverse event that is associated with GDM is that it has led to higher incidence of maternal diabetes mellitus later in life and the major morbidities among the infants born to the diabetic mothers include respiratory distress, macrosomia, polycythaemia, hypoglycaemia, hypocalcaemia, hypomagnesemia, and congenital malformations. As most of the oral hypoglycaemic agents is prone to cause teratogenic effects the most preferred was the insulin therapy and the subcutaneous insulin therapy has been considered as the standard therapy in the management of GDM. Aim: To assess the factors associated in the incidence of diabetes among the gestational diabetes mothers and to assess the effect of insulin on them in terms of maternal and foetal outcome. Methodology: A prospective study was undertaken among the gestational mothers with diabetes for a period of one year during Jan 2015 – Dec 2015 at the Government Medical College Hospital, Salem. A total of 150 maternal mothers with more than 24 weeks of gestation were included in the study and who had been diagnosed as gestational diabetes mellitus. The insulin used for majority of the patients was novo rapid and it was used four times a day. The outcome parameters which were used for antenatal mothers were their weight gain and the type of complications at the time of delivery whereas for the neonates their birth weight and the necessity for NICU admission were considered as the outcome parameters. Results: the risk factors found to be associated with the gestational diabetes among the study population were age more than 30 years, BMI of more than 25, family history both father and mother being diabetic, having a bad obstetric history, primigravida and the mothers who had gained more than 7 kgs in the first two trimesters. majority of the mothers delivered macrosomia babies (29.3%), hypoglycaemia and hypothyroidism was found only in 6% and 5.3% of the new-born babies and 4 were still births and 15 babies were got admitted to NICU for respiratory distress. The pearson’s correlation had shown a strong positive correlation between the dose of the insulin given to the antenatal mother and their increase in the weight (r=0.819) and a strong negative correlation with the weight of the neonate (r= -0.532). Conclusions: Gestational diabetes mellitus being associated with maternal and neonatal adverse outcomes, so maintaining adequate blood glucose levels in GDM helps in reducing the morbidity for both the mother and baby. Insulin would be a right choice for treating GDM and when initiated early it prevents most of the complications due to GDM both in the mother and the neonate.

Translation of fetal abdominal circumference-guided therapy of gestational diabetes complicated by maternal obesity to a clinical outpatient setting

Objective: To evaluate the effectiveness of fetal abdominal circumference-guided therapy for gestational diabetes (GDM) in an outpatient population characterized by highly-prevalent maternal obesity.Methods: Data for this translational retrospective cohort study come from medical records. Fetal abdominal circumference was assessed by ultrasound in late second trimester, and sex- and gestational age-specific percentiles assigned. Taking fetal abdominal circumference percentile as a marker for adequacy of fetal growth, maternal glucose targets were set accordingly: loose, moderate or tight. Associations between mother’s targets and neonatal outcomes (small for gestational age (SGA), large for gestational age (LGA), macrosomia, neonatal intensive care unit (NICU) admission, and neonatal hypoglycemia) were assessed using unconditional logistic regression, controlling for pre-gravid body mass index (BMI) and gestational weight gain.Results: In 419 consecutive pregnancies complicated by GDM, neonatal outcomes compared favorably with previous randomized trials of intensive GDM management. Importantly, adverse outcomes were observed less often than might be expected in an obese GDM population. BMI did not have an independent effect on neonatal outcomes.Conclusions: Ultrasound-guided therapy of GDM, in general clinic use, can limit excess macrosomia and LGA, even in a population with significant maternal obesity.

Gestational diabetes: An overview with attention for developing countries.

Gestational diabetes mellitus (GDM) is defined as a glucose intolerance that occurs for the first time or it is first identified during pregnancy. The GDM etiology is multifactorial. It has not completely been established yet and several known risk factors may contribute to its onset. To date, there are no shared guidelines on the management and follow-up, especially regarding the low-income countries. In this paper, we describe the state of art about epidemiology, physiopathology, diagnosis, and management of GDM. Moreover, we focus on the current state in low income countries trying to outline basis for further research.

Monitoring and Evaluation Mechanism for Multi- Center Capacity Building Gestational Diabetes Program for Physicians in India

M and E for a program requires identification of indicators that measure inputs, process, outputs, and outcomes. The frequency of collecting information for these indicators will vary depending on the level of use, type of indicator as well as time interval over which we expect to see a change in that parameter. For effective M and E of CCGDM a list of indicators and parameters has been finalized. Following tools and techniques will be used for effective monitoring of CCGDM Cycle III.1.Base line &amp; End line Questionnaire: Baseline and End Line survey is employed to assess Knowledge Attitude Practices of GDM among participants. The questionnaire comprises of 20 MCQ’s pertaining to screening, diagnosis, treatment, prevention and management of GDM. Baseline was circulated to all enrolled participants during Module I session just before pre test. End Line questionnaire will be distributed to participants subsequent to completion of Module IV to ascertain the shift of knowledge before and after the course. The responses will be entered in an excel template and analyzed.2. Monitoring Forms and Formats:Standardized forms which help in capturing and collection of data in a systematic and uniform manner PAN India from all stakeholders. Five forms which were used in monitoring of CCGDM Cycle I were: Observers Checklist, Participant Feedback Form, Trainer Feedback Form, Participant Testimonial Form and Trainer Testimonial Form.3. SMS Real Time Monitoring System: The SMS Real Time Monitoring System is a state of the art reporting mechanism which will allow the Observers to report on selected pre-defined parameters during the on-site monitoring of the contact sessions. Each parameter had a pre-defined code which was entered in SMS message and sent to the CCGDM Program Secretariat on a designated number. Each Observers mobile number has been registered with the system and a unique code was maintained throughout the tenure of the program. The Observers use this code developed for the parameters to construct the SMS, which when sent is collected at CCGDM Program Secretariat. This system in turn was allowing for meticulous and timely follow up by the management.End Line Evaluation Survey:The evaluation for CCGDM Cycle III will be conducted in the month of November 2015, following the completion of Module IV in October 2014. The evaluation will enable us to amalgamate the overall experiences of the participants during the program. It will also help us to measure the improvement in the knowledge and skills of all eligible participants of CCGDM Cycle II in the field of Gestational Diabetes Mellitus.

GESTATIONAL DIABETES. OBSTETRICAL PERSPECTIVE.

This review discusses current international recommendations for GDM diagnosis and management and argues whether it would be worth considering first, universal screening for GDM in our country, second, updating of management guidelines and third, organized follow-up of women diagnosed with GDM and adoption of lifestyle interventions after delivery that could reduce the onset and prevalence of type 2 DM.

Detection and Management of Diabetes during Pregnancy in Low Resource Settings: Insights into Past and Present Clinical Practices.

Background. Timely and adequate treatment is important to limit complications of diabetes affecting pregnancy, but there is a lack of knowledge on how these women are managed in low resource settings. Objective. To identify modalities of gestational diabetes detection and management in low and lower middle income countries. Methods. We conducted a scoping review of published literature and searched the databases PubMed, Web of Science, Embase, and African Index Medicus. We included all articles published until April 24, 2016, containing information on clinical practices of detection and management of gestational diabetes irrespective of publication date or language. Results. We identified 23 articles mainly from Asia and sub-Saharan Africa. The majority of studies were conducted in large tertiary care centers and hospital admission was reported in a third of publications. Ambulatory follow-up was generally done by weekly to fortnightly visits, whereas self-monitoring of blood glucose was not the norm. The cesarean section rate for pregnancies affected by diabetes ranged between 20% and 89%. Referral of newborns to special care units was common. Conclusion. The variety of reported provider practices underlines the importance of promoting latest consensus guidelines on GDM screening and management and the dissemination of information regarding their implementation.

Evaluation of prevalence and risk factors of gestational diabetes in a tertiary care hospital in Kerala

AimsThe prospective study was conducted with the aim to evaluate the prevalence and risk factors of gestational diabetes mellitus in a tertiary care referral hospital in Kerala. Materials and MethodsA prospective observational study was conducted with the aim to study the prevalence, risk factors, complications, treatment pattern and cost analysis of GDM. The study was carried out in the Obstetrics & Gynecology dDepartment of Al Shifa hHospital located in northern Kerala. ResultsOver an eight-month period, 201 patients who met the inclusion criteria were enrolled for study from which prevalence of GDM was estimated at 15.9%. The study revealed higher prevalence of risk factors and complications such as age >25 years, BMI >26kg/m2, family history of DM, past history GDM, history of big baby, gestational hypertension, vaginal candidiasis, premature rupture of membranes and hyperbilirubinemia in GDM group as compared to non-GDM group. The study also demonstrated that modern life-style was a major influencing factor for development of diabetes in the study population. ConclusionThe study reveals the necessity of proper screening diagnosis and management of GDM in pregnant women by the clinicians so as to prevent the future burden of type 2 diabetes.

A Comparison of Insulin and Glibenclamide in the Treatment of Gestational Diabetes Mellitus

Background and objectives: Gestational Diabetes Mellitus is an important medical disorder in pregnancy which is amenable to treatment thereby improving the maternal and neonatal morbidities to a great extent. Insulin has been the gold standard for management of GDM but has many demerits as far as patient acceptance and compliance are concerned. Oral hypoglycemic agents if proven safe can revolutionise the treatment of GDM. The present study aims to compare the efficacy of insulin and glibenclamide in the treatment of GDM and also to analyse the maternal and neonatal outcomes. Methods: It is a prospective observational study carried out in our institution. 100 antenatal patients diagnosed as GDM by standard criteria were recruited and randomized to two study arms of 50 each. Group A was started on insulin and Group B was started on glibenclamide upto a maximum dose of 20 mg per day. Capillary blood glucose levels were monitored and patients were followed up till delivery and neonatal outcomes also were analysed. Results: One week after starting treatment 72% of Group A and 68% of Group B achieved target levels of blood glucose and the difference was not statistically different. Before delivery 88% in Group A and 86% in Group B had values within normal range. The reduction in fasting blood glucose levels in glibenclamide group before delivery was statistically significant. The incidence of maternal and neonatal morbidities was comparable in both the groups.8% of patients had treatment failure with glibenclamide and were switched over to insulin. Conclusion: Glibenclamide appears to be an effective treatment agent in GDM with maternal and neonatal outcomes comparable with insulin. Studies involving more number of patients are still needed before glibenclamide can be considered as an effective alternative to insulin. Keywords: Gestational diabetes mellitus, Insulin, Glibenclamide, Target blood glucose levels, Maternal and neonatal morbidities