Management Of Gestational Diabetes Mellitus Research Articles

Investigation on the Association of Maternal Serum Visfatin Concentration with Gestational Diabetes Mellitus

Introduction: Gestational diabetes mellitus (GDM) is a common pregnancy complication that can have adverse effects on both the mother and the child. Visfatin, an adipokine, has been suggested to play a role in the pathogenesis of GDM. Still, the association between maternal serum visfatin concentration and GDM remains unclear, particularly in the Bangladeshi female population. This study investigated the association between maternal serum visfatin concentration and GDM in the Bangladeshi female population. Methods: A total of 69 patients participated in this study, including 34 patients with gestational diabetes mellitus (GDM, cases) and 35 patients without GDM (non-GDM, controls). Maternal age, gravida, pre-pregnancy BMI, family history of diabetes, fasting glucose, fasting insulin, HOMA-IR, and lipid profile were assessed. Serum visfatin concentrations were measured and compared between the two groups. Results: The GDM group had significantly lower serum visfatin concentrations compared to the non-GDM group (0.72±0.38 ng/ml vs 1.12±0.7 ng/ml, p<0.001). The Mean±SD of fasting glucose, fasting insulin, and HOMA-IR were 5.83±0.61, 15.77±3.95, and 4.07±1.09 respectively which were significantly higher in the GDM group. In the serum lipid profile study, the Mean±SD value of TG and HDL (3.05±0.82 and 1.63±0.32) in the GDM group were also significantly higher than that of the non-GDM group (2.45±0.88 and 1.49±0.36) (P < 0.05). Conclusions: This study suggests that lower maternal serum visfatin concentrations are associated with GDM and visfatin levels are inversely related to insulin resistance in women with GDM. Consequently, a potential role of visfatin in the pathogenesis and management of GDM is associated with the Bangladeshi population and thus visfatin may represent a novel diagnostic or prognostic biomarker for GDM. Therefore, further research will be valuable to elucidate the underlying mechanisms and explore the clinical implications of these associations.

Predictive Utility of Biochemical Markers for the Diagnosis and Prognosis of Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM) is a common complication during pregnancy with an increasing prevalence worldwide. Early prediction of GDM and its associated adverse outcomes is crucial for timely intervention and improved maternal and fetal health. The objective of this review is to provide a comprehensive summary of contemporary evidence on biomarkers, focusing on their potential to predict the development of GDM and serve as predictors of maternal, fetal, and neonatal outcomes in women with GDM. A literature search was conducted in the PubMed database using relevant terms. Original research articles published in English between 1 January 2015, and 30 June 2024, were included. A two-stage screening process was employed to identify studies on biomarkers for GDM diagnosis and prognosis and to evaluate the evidence for each biomarker's diagnostic performance and its potential prognostic correlation with GDM. Various biochemical markers, including adipokines, inflammatory markers, insulin resistance markers, glycemic markers, lipid profile markers, placenta-derived markers, and other related markers, have shown promise in identifying women at risk of developing GDM and predicting adverse pregnancy outcomes. Several promising markers with high predictive performance were identified. However, no single biomarker has demonstrated sufficient accuracy to replace the current diagnostic criteria for GDM. The complexity of multiple pathways in GDM pathogenesis highlights the need for a multi-marker approach to improve risk stratification and guide personalized management strategies. While significant progress has been made in GDM biomarker research, further studies are required to refine and validate these markers for clinical use and to develop a comprehensive, evidence-based approach to GDM prediction and management that can improve maternal and child health outcomes.

Postpartum Glucose Follow-up Screening Among Women With Gestational Diabetes Mellitus: A Retrospective Cohort Study

Abstract Objective To evaluate the impact of pre-gestational and gestational characteristics on postpartum glucose follow-up screening (PGFS) compliance in women diagnosed with gestational diabetes mellitus (GDM) in southwest China. Methods This retrospective cohort study was conducted in West China Second Hospital, Sichuan University. Pre-gestational and gestational factors were extracted from hospital records and compared between women who completed PGFS and those who did not. The screening method chosen was the 75g oral glucose tolerance test (OGTT), performed 4–12 weeks postpartum. Univariate analysis, logistic regression analysis, and Cochran-Armitage test were used to assess associations between maternal characteristics and PGFS compliance. Results A total of 3047 women with GDM were included, with a PGFS completion rate of 47.2%. Of those who completed PGFS, 430 women (29.9%) presented abnormal results: 1.8% with impaired fasting glucose (IFG), 24.1% with impaired glucose tolerance (IGT), 2.2% with both IFG and IGT 2.2%, and 1.8% with suspected diabetes. Independent factors associated with non-compliance to PGFS included higher pre-gestational BMI (odds ratio (OR): 0.952; 95% confidence interval (CI): 0.922, 0.984), multipara (OR: 0.721; 95% CI: 0.593, 0.877), use of assisted reproduction technology (ART) (OR: 1.427; 95% CI: 1.080, 1.885), excessive gestational weight gain (OR: 0.956; 95% CI: 0.936, 0.977), elevated fasting plasma glucose (FPG) prior to delivery (OR: 0.909; 95% CI: 0.835, 0.988), and undergoing cesarean section (OR: 1.232; 95% CI: 1.017, 1.492) were independent influencing factors of failing to PGFS. PGFS completion rates significantly decreased with increasing pre-gestational BMI and earlier gestational age (P < 0.001). Conclusions Establishing dedicated postpartum follow-up teams and targeting women with higher pre-gestational BMI, multiparity, ART use, excessive gestational weight gain, elevated pre-delivery FPG, and those undergoing cesarean section are critical to improving postpartum GDM management.

Comprehensive management of gestational diabetes mellitus: practical efficacy of exercise therapy and sustained intervention strategies.

Gestational Diabetes Mellitus (GDM) affects 14.0% of pregnancies globally, with a 35% post-pregnancy relapse and a 60% risk of Type 2 Diabetes (T2D) within 5-10 years. Challenges in long-term management, especially postpartum, include adherence and follow-up difficulties. This study, based on a systematic review and meta-analysis, examined the practical effects of exercise therapy in the prevention, treatment, and prevention of progression from Gestational Diabetes Mellitus (GDM) to Type 2 Diabetes (T2D). Relevant research and clinical practices were retrieved from six major databases (PubMed, Scopus, Web of Science, Cochrane Library, MEDLINE, Science Direct). After analyzing the intervention effects of exercise therapy at different stages, factors favorably influencing the effectiveness of exercise intervention were identified during the more effective stages. Finally, a long-term and efficient exercise implementation plan for the comprehensive management of GDM was proposed. In GDM prevention, exercise reduced the post-intervention risk by 37% compared to the control group (Relative Risk (RR)=0.63; 95% Confidence Interval (CI): 0.54 to 0.72; p=0.01). Studies on GDM treatment showed improved glucose control in the exercise group post-intervention (Mean Difference (MD)=-0.10; 95% CI: -0.16 to -0.04; p=0.04/MD=-0.27; 95% CI: -0.36 to -0.19; p<0.0001). However, exercise therapy didn't significantly affect the incidence of T2D post-GDM (RR=0.88; 95% CI: 0.69 to 1.11; p=0.39) due to challenges in quantified exercise prescriptions and the complexity of postpartum programs. To enhance exercise therapy effectiveness in GDM management, the study recommends adopting an integrated model emphasizing personalized pregnancy plans, postpartum strategies, and long-term support. Leveraging frequent healthcare contact during pregnancy can establish and sustain exercise habits, fostering a lifelong pattern. While the study acknowledges limitations, this approach holds potential for improving glycemic metabolism and developing healthy exercise habits in subsequent generations. Future research should include longer follow-ups to validate the practical efficacy of this approach in preventing T2D after GDM. https://www.crd.york.ac.uk/prospero, identifier CRD42023463617.

Non-Pharmacological Management of Gestational Diabetes Mellitus with a High Fasting Glycemic Parameter: A Hospital-Based Study in Vietnam

Background/Objectives: The prevalence of gestational diabetes mellitus (GDM) is increasing at an alarming rate worldwide. Delayed management can lead to adverse composite outcomes for both mother and her offspring. To our knowledge, the clinical association between glycemic parameters and the results of the non-pharmacological GDM approach remains limited; thus, this study aimed to address this important clinical issue in the literature. Methods: This was a retrospective cross-sectional study of 174 Vietnamese pregnant women with the positive oral glucose tolerance test (OGTT) for a high fasting glycemic parameter at Hung Vuong Hospital from 04/2022 to 07/2022. This study aimed to evaluate the success rate of GDM with an elevated index of fasting glycemic concentration which was managed after 2 weeks of a dietary regimen combined with adequate physical activities and to reveal its related factors. Results: Out of 174 singleton pregnancies that met the inclusion criteria, 103 GDM pregnant women were successfully managed after 2 weeks of monitoring (59.2%; 95% confidence intervals (CI): 51.9–66.5). The study revealed a fair correlation between the corresponding test of blood glucose at OGTT and after 2 weeks of GDM management (r = 0.270–0.290, p &lt; 0.0001). The GDM pregnant women with an elevated fasting glycemic parameter and with any of elevated 1 h or 2 h blood glucose levels and in cases of three elevated glycemic parameters (fasting, 1 h, and 2 h blood glucose at the initial results of OGTT) reduced the success rate of glycemic control to 56.5%, 49.2%, respectively, compared to the group with solely a high fasting index of blood glucose (69.6%). The pregnant women who participated in high-intensity sports activities related to a two-fold increase in success rate compared with the group engaging in light and moderate-intensity physical activity. Conclusions: The success rate of glycemic control in GDM women was highest in the group with solitary fasting hyperglycemia and lower in the contributory groups with two and three high parameters. The application of diet therapy plus physical activities among GDM pregnant women is potentially necessary to improve the effectiveness of treatment, minimize adverse pregnancy outcomes, and reduce substantially the hospitalization rate.

Gestational diabetes complicated with preterm birth: a retrospective cohort study

ObjectiveTo delineate the clinical characteristics of preterm birth (PTB) in the context of gestational diabetes mellitus (GDM).MethodsA retrospective cohort study was conducted, including 14,314 pregnant women with GDM who delivered at Fujian Provincial Maternity and Children’s Hospital from January 1, 2018, to December 31, 2021. PTB was stratified into late PTB (34–36 weeks of gestation) and early PTB (< 34 weeks) and pregnancy complications were analyzed.ResultsCompared to the term birth (TB) cohort, a higher prevalence of premature rupture of membranes, hypertensive diseases of pregnancy (HDP), intrahepatic cholestasis of pregnancy (ICP), anemia and cervical insufficiency was observed in the PTB cohort. Notably, early PTB increased the incidence of HDP, ICP, anemia and cervical insufficiency compared to late PTB. In the early stages of pregnancy, early PTB was characterized by elevated triglyceride (TG) levels and decreased high-density lipoprotein cholesterol (HDL-C) levels compared to late PTB. In the late pregnancy stages, early PTB was associated with increased white blood cell (WBC) and neutrophil counts. No disparities were observed in 75 g oral glucose tolerance test (OGTT) between early and late PTB.ConclusionEnhanced surveillance and management of GDM, particularly in the presence of HDP, ICP and anemia, are imperative to mitigate the risk of PTB. The lipid profile may serve as a predictive tool for early PTB in the early stages of pregnancy, warranting further studies.

Identification of key ubiquitination-related genes in gestational diabetes mellitus: A bioinformatics-driven study.

Gestational diabetes mellitus (GDM) is characterized by glucose intolerance that occurs during pregnancy. This study aimed to identify key ubiquitination-related genes associated with GDM pathogenesis. Microarray data from GSE154377 was analyzed to identify differentially expressed genes (DEGs) in GDM vs normal pregnancy samples. Weighted gene co-expression network analysis was performed on ubiquitination-related genes. Functional enrichment, protein-protein interaction network, and TF-mRNA-miRNA interaction network analyses were conducted on differentially expressed ubiquitination-related genes (DE-URGs). We identified 2337 DEGs and 65 DE-URGs in GDM. Functional enrichment analysis of the 65 DE-URGs revealed involvement in protein ubiquitination and ubiquitin-dependent catabolic processes. Protein-protein interaction network analysis identified 8 hub genes, including MAP1LC3C, USP26, USP6, UBE2U, USP2, USP43, UCHL1, and USP44. ROC curve analysis showed these hub genes have high diagnostic accuracy for GDM (AUC > 0.6). The TF-mRNA-miRNA interaction network suggested USP2 and UCHL1 may be key ubiquitination genes in GDM. In conclusion, this study contributes to our understanding of the molecular landscape of GDM by uncovering key ubiquitination-related genes. These findings may serve as a foundation for further investigations, offering potential biomarkers and therapeutic targets for clinical applications in GDM management.

Exploring the determinants of oral health care uptake among women with gestational diabetes mellitus: A qualitative study to develop a logic model and framework for an oral health intervention.

Gestational diabetes mellitus (GDM) is a condition of glucose intolerance in pregnancy. Oral health has been shown to mediate blood glucose management and pregnancy outcomes. There is also a greater prevalence of poor oral health in GDM pregnancies when compared to normoglycemic pregnancies. While current guidelines recommend an oral health review as part of diabetes and pregnancy management, it is under-considered in GDM care. Hence, it is important to understand how to improve oral health care in this context. To explore the determinants of oral health care uptake among women with GDM to develop a logic model for an intervention to improve awareness and activation of oral health behaviours in this population. Semi-structured interviews were used to collect the data and the Theoretical Domains Framework inspired the interview guide. The study population consisted of UK-based women with GDM over 18 years of age. The data were analysed with Framework Analysis and the COM-B Model was used to orientate the data. Seventeen women participated in the study. Five themes including knowledge about oral health; the health of the baby; the impact of the GDM diagnosis; social support and barriers and facilitators were found to influence the uptake of oral health care. This study developed an evidence-based logic model of the determinants of oral health care uptake among women with GDM. This will serve as a framework for developing an oral health intervention. This study may be the starting point for initiating conversations about implementing oral health care in GDM management.

Utilization of Smart Healthcare for Gestational Diabetes Mellitus Management

Gestational diabetes mellitus (GDM) poses significant health risks to both mothers and newborns, requiring rigorous self-management and frequent medical consultations. Advances in information and communications technology (ICT) have shown promising results in reducing the number of in-person visits for GDM management. ICT enhances patient self-care engagement, with some studies reporting reductions in average blood glucose and HbA1c levels. ICT for GDM management has demonstrated benefits such as fewer in-person visits, improved adherence to self-monitoring of blood glucose, increased global user satisfaction, and maintenance of blood glucose control and perinatal outcomes. Common barriers to ICT for GDM include technological literacy, inadequate education, limited technical support, the additional burden of non-customized applications, and restricted interoperability. Further research is needed on the impact of technology on GDM management to optimize digital health solutions.

Probiotic therapy as a promising strategy for gestational diabetes mellitus management.

Gestational diabetes mellitus (GDM) has become the most common pregnancy medical complication, and its prevalence has increased in recent years. The GDM treatment primarily relies on adopting healthy eating habits, physical exercise, and insulin therapy. However, using probiotics to modulate the gut microbiota has been the subject of clinical trials as a promising therapeutic strategy for GDM management. Due to the adverse effects of gut dysbiosis in women with GDM, strategies targeting the gut microbiota to mitigate hyperglycemia, low-grade inflammation, and adverse pregnancy outcomes have been explored. Probiotic supplementation may improve glucose metabolism, lipid profile, oxidative stress, inflammation, and blood pressure in women with GDM. Furthermore, decreased fasting blood glucose, insulin resistance, and inflammatory markers, such as TNF-α and CRP, as well as increased total antioxidant capacity, lipid profile modulation, and improved blood pressure in women with GDM, are some of the important results reported in the available literature. To fill the knowledge gap, further studies are needed focusing on modulating gut microbiota composition and metabolic activity and their systemic repercussions in GDM.

Advances in Understanding and Managing Gestational Diabetes Mellitus: A Comprehensive Review

Gestational Diabetes Mellitus (GDM) is a significant and growing concern in prenatal care, impacting maternal and neonatal health. This comprehensive review highlights recent advancements in the understanding and management of GDM. The pathophysiology of GDM involves complex interactions between genetic, environmental, and hormonal factors that disrupt glucose homeostasis during pregnancy. Improved screening techniques and diagnostic criteria have led to earlier and more accurate detection. Management strategies have evolved to include not only traditional lifestyle interventions such as diet and exercise but also novel pharmacological treatments and continuous glucose monitoring technologies. The role of multidisciplinary care teams in optimizing pregnancy outcomes is emphasized, ensuring tailored care that addresses the unique needs of each patient. Additionally, the review explores emerging research on the long-term implications of GDM for both mother and child, underscoring the importance of postpartum follow-up and preventive measures. These advancements collectively aim to enhance maternal and fetal outcomes, reduce complications, and provide a framework for future research and clinical practice in GDM.

A randomized controlled trial comparing two antenatal care regimes in the management of mild to moderate gestational diabetes in a low-middle income country.

The prevalence of gestational diabetes mellitus (GDM) in the Indian subcontinent has increased exponentially, especially after new diagnostic criteria. Identifying women who need close monitoring is a challenge. Ultrasound has been used to guide therapy but its use in the management of GDM has been used indiscriminately due to paucity of information. The use of ultrasound to guide the number of antenatal visits for adequate glycemic control has not been researched adequately. There is also a need to contrive antenatal care strategies that can obtain optimal neonatal outcomes without burdening the health system in low-middle income countries (LMIC). Our study was to compare pragmatic standard management of GDM with an ultrasound-guided regime (USGR) to prevent neonatal complications to ensure optimal care. A randomized controlled trial was done in a tertiary hospital between May 2019 and September 2021 in South India. Five hundred and eighty-eight women were randomized to a standard regime or USGR. χ2 and t-test were used to compare outcomes. Maternal and neonatal outcomes between standard and ultrasound USGR showed no significant difference in outcomes. Fetuses in USGR with AC ≥ 70th centile had macrosomia (3.59% vs 26.67%, P < 0.001), increased severity of diabetes (2.97% vs 16.67%, P < 0.001), 3rd- and 4th-degree perineal tear (2.95% vs 27.27%, P < 0.001). The increased number of visits did not decrease adverse outcomes. This small well-designed study did not show any advantage with USGR as compared to the pragmatic simple standard regime, in the treatment of women with GDM.

Genetic and Biotechnological Approaches to Gestational Diabetes Mellitus: Advancing Diagnostics, Treatment Strategies, and Public Health Implications.

Background Gestational diabetes mellitus (GDM) is a disorder where pregnant women have difficulty processing glucose, which influences the mother's and the fetus's health. The rising prevalence of GDM, often linked to obesity, highlights the need to study its processes and develop appropriate treatment techniques. Conventional diagnostic approaches may not accurately anticipate or address genetic predispositions, emphasizing the need for further investigation. Objective This study aims to explore genetic and biotechnological approaches to improve diagnostics, treatment, and public health strategies for GDM. Methodology This research was carried out in two hospitals in Pakistan over a period of 12 months, from January to December 2023. A sample size of 260 was determined using an anticipated GDM prevalence of 15%. The data were obtained by administering structured questionnaires, doing anthropometric measures, and analyzing blood samples for genetic information. The statistical study included the use of descriptive statistics, chi-square tests, and logistic regression to examine the relationships between genetic markers and the risk of GDM. The significance level of these associations was assessed using a p-value of <0.05. Results Among the 260 individuals with GDM included in the research, 52 (20.00%) and 73 (28.08%) patients had the TCF7L2 risk variation. The study found that the TCF7L2 and FTO risk polymorphisms were linked to a higher likelihood of developing GDMamong the participants. The association was statistically significant, with p-values of 0.012 and 0.045, respectively. Logistic regression analysis showed that the TCF7L2 risk variant had an odds ratio of 2.35 (95% confidence interval [CI]: 1.21-4.56, p = 0.012), while the FTO risk variant had an odds ratio of 1.97 (95% CI: 1.05-3.70, p = 0.045). There is a substantial association between consuming a large amount of sugar (OR: 2.10, 95% CI: 1.15-3.82, p = 0.017) and engaging in little physical activity (OR: 1.85, 95% CI: 1.07-3.22, p = 0.025) and an increased risk of GDM. Treatment brought the glucose levels of people with GDM down to normal in 68.49% of cases. Conclusion Integrating genetic screening for TCF7L2 and FTO variants with lifestyle modifications may enhance early detection and personalized management of GDM, leading to improved maternal and fetal health outcomes.

Adverse pregnancy outcomes with respect to treatment modalities in women with gestational diabetes mellitus at a rural tertiary care teaching hospital.

To estimate the prevalence of gestational diabetes mellitus (GDM) and compare adverse pregnancy outcomes with respect to treatment modalities in a peri-urban teaching hospital in Telangana. A prospective study was conducted on GDM cases delivered from January 2019 to March 2020. GDM was diagnosed using a two-step procedure of screening using IADPSG criteria. Women diagnosed with GDM were divided into four groups - diet group, metformin group, metformin plus insulin group and insulin group based on the treatment modalities. Adverse pregnancy outcomes of the women managed with different treatment modalities were recorded. Good glycaemic control (FBS, P = 0.04, 2 hrs PLBS, P = 0.01) was achieved in diet and metformin groups. Incidence of Gestational hypertension (P = 0.01) and preeclampsia (P = 0.01) were found to be higher in the insulin group when compared to the metformin and insulin group, metformin group and diet group. No difference was noted with respect to polyhydramnios, preterm birth, premature rupture of membranes, induction labour and caesarean delivery rates between the treatment groups. Apgar score at 5 min of <7 (P = 0.02), neonatal intensive care unit admissions for >24 hrs (P = 0.03) and neonatal hypoglycaemia (P = 0.01) were found to be higher in insulin-required groups. Rates of shoulder dystocia, stillbirth, early neonatal death within 1 week and respiratory distress did not vary significantly between the treatment groups. Universal screening of women for GDM and multidisciplinary management of women once diagnosed tend to lessen maternal and fetal complications. Metformin can be an effective, cheaper and non-invasive alternative to insulin in the management of GDM.

Impairments of insulin and glucagon sensitivity in Chinese women with gestational diabetes mellitus.

To evaluate insulin and glucagon sensitivity in Han Chinese women with and without gestational diabetes mellitus (GDM). In total, 81 women with GDM and 81 age-matched healthy controls were evaluated with a 75 g oral glucose tolerance test (OGTT) at gestational weeks 24-28. Plasma glucose concentrations were measured at fasting and 1 h and 2 h post-OGTT. Fasting plasma insulin, glucagon and amino acids were also measured. Insulin and glucagon sensitivity were assessed by the homeostatic model assessment of insulin resistance (HOMA-IR) and glucagon-alanine index, respectively. As expected, plasma glucose concentrations were higher at fasting and 1 h and 2 h post-OGTT in GDM participants (p < .001 each). Both the HOMA-IR and the glucagon-alanine index were higher in GDM participants. There was a weak positive correlation between HOMA-IR and glucagon-alanine index (r = 0.24, p = .0024). Combining the HOMA-IR and the glucagon-alanine index yielded better capacity (area under the curve = 0.878) than either alone (area under the curve = 0.828 for HOMA-IR and 0.751 for glucagon-alanine index, respectively) in differentiating GDM from healthy participants. While the majority of GDM participants (64%) exhibited both reduced insulin and glucagon sensitivity, a third of them presented either reduced insulin (20%) or glucagon (14%) sensitivity alone. HOMA-IR and glucagon-alanine index correlated differentially with fasting glucose, triglycerides, low-density lipoprotein cholesterol, sum of amino acids and hepatic steatosis index. Impairments of both insulin and glucagon sensitivity occur frequently in Chinese women with GDM, which may, individually or together, drive metabolic derangements in GDM. These observations provide new insights into the pathophysiology of GDM and support the need to target insulin or glucagon resistance, or both, in the management of GDM.

Improving gestational diabetes care: Mobile glucose monitoring to reduce complications

BackgroundGestational diabetes mellitus (GDM) incurs risks for both mother and baby and requires close medical attention throughout pregnancy. This retrospective study examined the impact of myDiabby® software on GDM care and complications. Material and methodsThe study population was divided between a pre-MyDiabby® group, with traditional monitoring before September 2017, and a myDiabby® group, using the myDiabby® app after September 2017. The aim was to compare the main complications of GDM and blood glucose control between the two groups, using Fisher's exact test or bilateral Student t-test as appropriate. Backward logistic regression was used to identify independent factors associated with glycemic control and caesarean section (C-section). ResultsThere were 622 pre-myDiabby® and 649 myDiabby® patients. The myDiabby® group showed significantly lower risk of C-section (17.2% vs. 11.3%, P=0.004). After adjustment for pre-pregnancy body mass index (BMI), maternal age, prematurity, macrosomia and eclampsia, telemedicine was independently associated with a lower rate of C-section (OR=0.67, 95% CI: 0.51–0.89, P=0.005). Glycemic control improved (66.6% vs. 85.4%, P<0.001), with only a trend for need of insulin treatment. MyDiabby® remained associated with glycemic control (OR=3.15, 95% CI: 2.87–4.33, P<0.001) independently of pre-pregnancy BMI, insulin treatment or personal history of GDM. ConclusionThese findings highlight the potential benefits of using telemedicine tools in the management of GDM during pregnancy.

Circular RNA hsa_circ_0002268 (PHACTR1) Is Specific to Gestational Diabetes Mellitus in a Polish Pregnant Population.

Gestational diabetes mellitus (GDM) is an intolerance of carbohydrate of any degree, which appears for the first time or is diagnosed during pregnancy. The objective of this study is to assess the differences in circular RNA (circRNA) in a Polish pregnant population with and without GDM. A total of 62 pregnant women, 34 with GDM and 28 controls, were enrolled in the study. Total RNAs were extracted from plasma and reverse transcription to complementary DNA (cDNA) was performed. A panel covering 271 amplicons, targeting both linear and circular as well as negative control gene transcripts, was used. Next-generation sequencing was used to evaluate the circRNA quantity. Data analysis was performed using the Coverage Analysis plugin in the Torrent Suite Software (Torrent Suite 5.12.3). A two-step normalization was performed by dividing each transcript read count by the total number of reads generated for the sample, followed by dividing the quantity of each transcript by β-actin gene expression. Both circular and linear forms of RNAs were independently evaluated. A total of 57 transcripts were dysregulated between pregnant women with GDM and controls. Most of the targets (n = 25) were downregulated (cut-off ratio below 0.5), and one target showed a trend toward strong upregulation (ratio 1.45). A total of 39 targets were positively correlated with fasting plasma glucose (FPG), but none of the tested targets were correlated with insulin, CRP or HOMA-IR levels. Among the pregnant women with gestational diabetes, the relative quantity of hsa_circ_0002268 (PHACTR1) was approximately 120% higher than among healthy pregnant women: 0.046 [0.022-0.096] vs. 0.021 [0.007-0.047], respectively, (p = 0.0029). Elevated levels of hsa_circ_0002268 (PHACTR1) might be specific to the Polish population of pregnant women with GDM, making it useful as a potential molecular biomarker in the management of GDM in Poland.

Insulin Management for Gestational and Type 2 Diabetes in Pregnancy.

Insulin is preferred as the first-line agent for glucose management of gestational diabetes mellitus and type 2 diabetes in pregnancy when nutritional and lifestyle modifications are unable to achieve pregnancy-specific glucose targets. Individual heterogeneity in defects of insulin secretion or sensitivity in liver and muscle, unique genetic influences on pregnancy glycemic regulation, and variable cultural and lifestyle behaviors that affect meal, activity, sleep, and occupational schedules necessitate a personalized approach to insulin regimens. Newer insulin preparations have been developed to mimic the physiologic release of endogenous insulin, maintaining appropriate basal levels to cover hepatic gluconeogenesis and simulate the rapid, meal-related, bolus rise of insulin. Such physiologic basal-bolus dosing of insulin can be administered safely, achieving tighter glycemic control while reducing episodes of hypoglycemia. Insulin initiation and titration require understanding the pharmacodynamics of different insulin preparations in addition to a patient's glycemic profiles, effect of variable nutritional intake and mealtimes, physical activity, stress, timing of sleep cycles, and cultural habits. Educating and empowering patients to learn how their glucose responds to insulin, portion and content of meals, and physical activity can increase personal engagement in therapy, flexibility in eating patterns, and improved glycemic control. This Clinical Expert Series article is focused on optimizing insulin management (initiation, dosing, and titration) of gestational and type 2 diabetes in pregnancy.

The experiences of individuals who have had gestational diabetes: A qualitative exploration.

To qualitatively explore the experiences of individuals with Gestational Diabetes Mellitus (GDM) in Australia, and to recognise opportunities for leveraging digital health to enhance the support of GDM management. A cross sectional online survey assessed the experiences of individuals with GDM, the healthcare system and their digital health usage. Respondents (recruited via a national diabetes registry or social media) were adults receiving GDM care within Australia in the last 5 years, who responded to any of three open-ended questions (n = 815) exploring positive, negative and other GDM experiences. Thematic analysis was utilised, and themes were mapped to the socio-ecological systems framework. At a system level, themes related to (1) accessibility of care including the value of digital health and the inflexible or inconsistent perception of the (2) implementation of guidelines. At an interpersonal level, themes covered the need for adequate (3) health information provision, and (4) supportive care, as well as highlighting (5) experiences of stigma including a desire for greater awareness of GDM. Individual-level themes included: (6) differential barriers to accessing care; (7) negative emotional burden; (8) internalisation of stigma; (9) dietary freedom and social impact and (10) opportunity for change derived from having GDM. Findings suggest a demand for more supportive, person-centred GDM care, improved information provision and individualised implementation of clinical guidelines. Such mechanisms may support reduced barriers to accessing care or negative psychosocial impacts of GDM. Though not central to the identified experiences, digital health tools may help address the need for optimised GDM care.

Should midwives screen for gestational diabetes mellitus (GDM)?

Should we or shouldn't we engage in screening programmes for the detection and management of gestational diabetes mellitus? In this article, we review the Society of Obstetricians and Gynaecologists (SOGC) guidelines on screening for gestational diabetes mellitus and the evidence that led to these guidelines. We also reassess the recommendations in view of a recently published large randomized controlled trial.