Optimal management of gestational diabetes

2019 ◽  
Vol 131 (1) ◽  
pp. 97-108
Author(s):  
Aoife M Egan ◽  
Fidelma P Dunne
Keyword(s):  
Gestational Diabetes ◽  
Post Partum ◽  
Nutrition Therapy ◽  
Economic Benefits ◽  
Self Monitoring ◽  
Novel Technologies ◽  
Glucose Levels ◽  
Cell Dysfunction ◽  
Blood Glucose Levels ◽  
New Biomarkers

Abstract Background Gestational diabetes mellitus (GDM) is highly prevalent and has both short- and long-term implications for mother and infant. Sources of data Literature search using PubMed with keywords ‘Gestational diabetes’ and ‘diabetes in pregnancy’ together with published papers known to the authors. Areas of agreement The cornerstone of management is medical nutrition therapy with regular self-monitoring of capillary blood glucose levels and intensification of therapy if glycaemic goals are not achieved. Post-partum, annual assessment for type 2 diabetes is recommended. Areas of controversy Diagnostic criteria and new biomarkers for GDM and the clinical and economic benefits of treating women with milder levels of glucose intolerance during pregnancy. Growing points Women with GDM are a heterogeneous group with varying degrees of insulin resistance and beta cell dysfunction. Areas timely for developing research Development of alternative diagnostic markers and application of novel technologies for GDM management.

Searching for Utopia, the Challenge of Standardized Medical Nutrition Therapy Prescription in Gestational Diabetes Mellitus Management: A Critical Review

2021 ◽  
Author(s):  
Nina Meloncelli ◽  
Shelley A. Wilkinson ◽  
Susan de Jersey
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Lifestyle Modification ◽  
Nutrition Therapy ◽  
Medical Nutrition Therapy ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Medical Nutrition

AbstractGestational diabetes mellitus (GDM) is a common pregnancy disorder and the incidence is increasing worldwide. GDM is associated with adverse maternal outcomes which may be reduced with proper management. Lifestyle modification in the form of medical nutrition therapy and physical activity, as well as self-monitoring of blood glucose levels, is the cornerstone of GDM management. Inevitably, the search for the “ultimate” diet prescription has been ongoing. Identifying the amount and type of carbohydrate to maintain blood glucose levels below targets while balancing the nutritional requirements of pregnancy and achieving gestational weight gain within recommendations is challenging. Recent developments in the area of the gut microbiota and its impact on glycemic response add another layer of complexity to the success of medical nutrition therapy. This review critically explores the challenges to dietary prescription for GDM and why utopia may never be found.

Applications for self-monitoring of gestational diabetes mellitus in pregnancy; part of the improvement of connected health in Europe (Preprint)

2019 ◽  
Author(s):  
Kristina Drusany Starič ◽  
Vladimir Trajkovik ◽  
Hrvoje Belani ◽  
Petra Bukovec
Keyword(s):  
Gestational Diabetes ◽  
Mobile Applications ◽  
Positive Impact ◽  
Mobile Apps ◽  
Rapid Development ◽  
Self Monitoring ◽  
Healthy Behaviors ◽  
Connected Health ◽  
Glucose Levels ◽  
Blood Glucose Levels

BACKGROUND The rapid development of mobile application technology and personalized medicine also in Europe, stimulate the self-monitoring. Self-monitoring allows the patient to actively participate in the treatment process, with a positive impact on the result of the treatment. Mobile applications thus offer a new way to promote healthy behaviors, such as healthy diet, physical activity and measurement of blood glucose levels in the care for women with gestational diabetes. However, there are many factors, which make significant barriers preventing wide use of mobile applications in general medical praxis. OBJECTIVE The main aim of this study is to evaluate the most commonly used mobile apps used to manage gestational diabetes and compare them to each other. METHODS This paper presents a study, which investigates the mobile applications that can potentially support controlling of the blood sugar in pregnant women. After a broad overview of mobile applications on the Google Play Store and iTunes, we found 90 mobile applications that fit our keywords search terms and our inclusion criteria. Among these 90 applications, only 4 were designed for the management of gestational diabetes and not diabetes in general. All 4 were downloaded and analysed. Among the rest 86 applications that were designed to manage diabetes in general we downloaded, evaluated and compared to each other 5 applications with the highest download rate. RESULTS The characteristics of the most commonly used applications were described. Differentiations between useful mobile applications were investigated. CONCLUSIONS Applications can provide support for women to act on a certain issue by themselves without visiting an obstetrician. Although most of the applications were very useful, we suggested improvements. The greatest policy concerns of connected health are quality, privacy and safety of the gathered data.

scholarly journals Glucose levels during gestational diabetes pregnancy and the risk of developing postpartum diabetes or prediabetes

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Chadakarn Phaloprakarn ◽  
Siriwan Tangjitgamol
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Gestational Diabetes ◽  
Confidence Interval ◽  
Control Group ◽  
Oral Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
The Impact

Abstract Background Blood glucose levels during pregnancy may reflect the severity of insulin secretory defects and/or insulin resistance during gestational diabetes mellitus (GDM) pregnancy. We hypothesized that suboptimal glycemic control in women with GDM could increase the risk of postpartum type 2 diabetes mellitus (T2DM) or prediabetes. Our objective was to evaluate the impact of plasma glucose levels throughout GDM pregnancy on the risk of postpartum T2DM or prediabetes. Methods The medical records of 706 women with GDM who underwent a postpartum 75-g, 2-hour oral glucose tolerance test at our institution between January 2011 and December 2018 were reviewed. These women were classified into 2 groups according to glycemic control during pregnancy: ≤ 1 occasion of either fasting glucose ≥ 95 mg/dL or 2-hour postprandial glucose ≥ 120 mg/dL was defined as optimal glycemic control or else was classified as suboptimal glycemic control. Rates of postpartum T2DM and prediabetes were compared between women with optimal (n = 505) and suboptimal (n = 201) glycemic control. Results The rates of postpartum T2DM and prediabetes were significantly higher in the suboptimal glycemic control group than in the optimal glycemic control group: 22.4% vs. 3.0%, P < 0.001 for T2DM and 45.3% vs. 23.5%, P < 0.001 for prediabetes. In a multivariate analysis, suboptimal glucose control during pregnancy was an independent risk factor for developing either postpartum T2DM or prediabetes. The adjusted odds ratios were 8.4 (95% confidence interval, 3.5–20.3) for T2DM and 3.9 (95% confidence interval, 2.5–6.1) for prediabetes. Conclusion Our findings suggest that blood glucose levels during GDM pregnancy have an impact on the risk of postpartum T2DM and prediabetes.

Glycemia under control

2021 ◽  
pp. 54-55
Author(s):  
Nadezhda Kalinina
Keyword(s):  
Mobile Application ◽  
Vascular Complications ◽  
Self Monitoring ◽  
Glucose Levels ◽  
Therapy Goals ◽  
Blood Glucose Levels ◽  
Number Of Patients ◽  
Patients With Diabetes ◽  
The Russian Federation ◽  
Do It Yourself

Diabetes mellitus (DM) has become a global and national menace. The number of patients with diabetes in the Russian Federation tallied roughly 5.1 million, according to the incidence of outpatient visits in 2020 [1]. “Do-it-yourself” regular measurements of blood glucose levels (self-monitoring) are one of the most important components in achieving the therapy goals for patients with diabetes and preventing severe vascular complications. Now that the technologies have caught on, new “smart” glucometers appeared, which enable remote control and significantly expand opportunities of DM monitoring due to free mobile application integration.

scholarly journals Iron overload is related to elevated blood glucose levels in obese children and aggravates high glucose-induced endothelial cell dysfunction in vitro

2020 ◽  
Vol 8 (1) ◽  
pp. e001426
Author(s):  
Wei Wu ◽  
Jinna Yuan ◽  
Yu Shen ◽  
Yunxian Yu ◽  
Xuefeng Chen ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Iron Overload ◽  
High Glucose ◽  
Metabolic Disorders ◽  
Control Group ◽  
Endothelial Cell Dysfunction ◽  
Obese Children ◽  
Glucose Levels ◽  
Cell Dysfunction ◽  
Blood Glucose Levels

IntroductionThis study was performed to investigate the role of iron overload in the early stage of hyperglycemia-induced vascular functional impairment.Research design and methodsA total of 196 obese children were enrolled, and data regarding ferritin levels, blood glucose levels, intima-media thickness of carotid arteries, liver function and fibrosis index, hemoglobin, blood pressure, blood lipids, and inflammation indicators were collected. Ferritin levels were compared with a control group, which consisted of 148 healthy non-obese children who were age-matched and gender-matched. Endothelial cells were cultured in high glucose medium and supplemented with ferric citrate with or without iron remover (deferoxamine), a reducing agent (N-acetyl-cysteine), or a nuclear factor-κB (NF-κB) inhibitor (BAY 11-7082). Apoptosis, oxidative stress, nitric oxide levels, and endothelin content were evaluated. DNA microarray analysis was performed to analyze the expression of genes in the NF-κB signaling pathway.ResultsObese children have significantly higher ferritin levels compared with the control group. Ferritin level was positively correlated with hemoglobin and was related to metabolic disorders, including impaired glucose tolerance, higher blood pressure, dyslipidemia, and impaired hepatic function. Endothelial cells treated with ferric citrate showed a significantly higher rate of apoptosis, higher levels of oxidative stress, and impaired vasomotor function under high glucose conditions. The above effects were rescued by treatment with an iron remover, reducing agent, or NF-κB inhibitor. Further, detection of phosphorylated-p65 distribution in cells confirmed activation of the NF-κB pathway. DNA microarrays and subsequent gene oncology enrichment analyses revealed the main processes activated in cells.ConclusionIncreased ferritin levels are related to impaired glucose tolerance and other metabolic disorders in obese children. At the cellular level, iron overload aggravated the endothelial cell dysfunction caused by high glucose.

scholarly journals Maintaining Blood Glucose Levels in Range (70–150 mg/dL) is Difficult in COVID-19 Compared to Non-COVID-19 ICU Patients—A Retrospective Analysis

2020 ◽  
Vol 9 (11) ◽  
pp. 3635
Author(s):  
Rajat Kapoor ◽  
Lava R. Timsina ◽  
Nupur Gupta ◽  
Harleen Kaur ◽  
Arianna J. Vidger ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Retrospective Analysis ◽  
Insulin Dose ◽  
Glucose Levels ◽  
Cell Dysfunction ◽  
Daily Insulin ◽  
Daily Insulin Dose ◽  
Blood Glucose Levels ◽  
Time In Range ◽  
Insulin Use

Beta cell dysfunction is suggested in patients with COVID-19 infections. Poor glycemic control in ICU is associated with poor patient outcomes. This is a single center, retrospective analysis of 562 patients in an intensive care unit from 1 March to 30 April 2020. We review the time in range (70–150 mg/dL) spent by critically ill COVID-19 patients and non-COVID-19 patients, along with the daily insulin use. Ninety-three in the COVID-19 cohort and 469 in the non-COVID-19 cohort were compared for percentage of blood glucose TIR (70–150 mg/dL) and average daily insulin use. The COVID-19 cohort spent significantly less TIR (70–150 mg/dL) compared to the non-COVID-19 cohort (44.4% vs. 68.5%). Daily average insulin use in the COVID-19 cohort was higher (8.37 units versus 6.17 units). ICU COVID-19 patients spent less time in range (70–150 mg/dL) and required higher daily insulin dose. A higher requirement for ventilator and days on ventilator was associated with a lower TIR. Mortality was lower for COVID-19 patients who achieved a higher TIR.

scholarly journals Optimizing Macronutrients in People with Diabetes

2018 ◽  
Vol 06 (02) ◽  
pp. 065-071 ◽  
Author(s):  
Lovely Gupta ◽  
Priti Lal ◽  
Deepak Khandelwal
Keyword(s):  
Diabetes Management ◽  
Insulin Dose ◽  
Nutrition Therapy ◽  
Postprandial Blood Glucose ◽  
Insulin Regimen ◽  
Patient Centered ◽  
Dietary Practices ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Central Pillar

AbstractDiverse dietary practices and nutritional counseling strategies are followed in the management of diabetes and its comorbidities. The dietary approaches practiced in India make use of calorie and nutrient counting to ensure patient-centered nutrition therapy in diabetes management. Macronutrient modulation is a central pillar of patient-centered medical nutrition therapy (MNT). Carbohydrates (CHO) are considered as the predominant macronutrient affecting postprandial blood glucose levels. The insulin-to-CHO ratio is used for calculating mealtime insulin doses among patients on insulin regimen. The aim of this article is to highlight challenges faced in planning MNT, modifying recommended dietary allowances for persons with diabetes, and suggesting solutions to overcome these. It also aims to understand the requirement of individual macronutrients and their impact on glycemia as well as insulin dose adjustment.

Accuracy of Devices for Self-Monitoring of Blood Glucose Including Hypoglycemic Blood Glucose Levels

Diabetes Care ◽  
1995 ◽  
Vol 18 (4) ◽  
pp. 587-588 ◽  
Author(s):  
P. D. Zenob ◽  
A. Keller ◽  
S. E. Jaeggi-Groisman ◽  
Y. Glatz
Keyword(s):  
Blood Glucose ◽  
Self Monitoring ◽  
Glucose Levels ◽  
Blood Glucose Levels
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