DESIGNER INSULINS IN GESTATIONAL DIABETES . DR.T.RAMANI DEVI MD DGO FICS FICOG RAMAKRISHNA NURSING HOME TRICHY. Maternal Diabetes Two lives.. Twice as special An oppurtunity for primary prevention. -Maternal health -Child health. Definition.
DR.T.RAMANI DEVI MD DGO FICS FICOG
RAMAKRISHNA NURSING HOME
Two lives.. Twice as special
An oppurtunity for primary prevention
GDM is defined as carbohydrate in tolerance of variable severity with onset or first recognition during pregnancy.
The definition is applicable regardless of whether insulin is used to treat the disease or if the condition persists after pregnancy.
It does not exclude the possibility that unrecognized glucose intolerance may have antedated the pregnancy
GDMGDM prevalence linked to background IGT rates
Agarwal S, Gupta AN. Gestational Diabetes. J Assoc Physicians India 1982;30:203
Ramachandran A, et .al., High prevalence of diabetes in an urban population in south India. BMJ 1988;3; 297(6648):587-90
Narendra J, Munichoodappa C, et al, Prevalence of glucose intolerance during pregnancy. Int J Diab Dev Countries 1991;11:2-4
Ramachandran A, Snehalatha c, Dharmaraj D, Viswanathan M. Prevalence of glucose intolerance in Asian Indians. Diabetes Care 1992; 15:1348-55
Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V,Das AK, Rao PV, Yajnik CS, Prasanna Kumar KM, Nair JD.For the Diabetes Epidemiology Study Group in India (DESI).Diabetologia 2001;44:1094-1101.
V Seshiah, V Balaji, Madhuri S Balaji, CB Sanjeevi, A. Green. Gestational Diabetes Mellitus in India. J Assoc Physicians India 2004;52:707
Hyperglycaemia during pregnancy is associated with high risk of maternal and perinatal morbidity and mortality and poor pregnancy outcome
Maternal hyperglycaemia is associated with development of metabolic problems including type 2 diabetes in the offspring
Diagnosis of GDM identifies women at high risk of future diabetes, offers opportunity of primary preventionDiabetes and Pregnancy – Why it is relevant?
SolutionOptimal nutrition+ Optimal glycemic control=Optimal birth weight 3000 – 3500 g.
Died after birth
Big baby ( 3.5 kg)
NGT (n = 851)
9 / 831
GDM (n =211)
11 / 148
Clausen TD et al., Diabetes Care 2008
e-health, will revolutionize the management of GDM
30 kcal per kg current weight per day in pregnant women who are BMI 22 to 25.
24 kcal per kg current weight per day in overweight pregnant women (BMI 26 to 29).
12 to 15 kcal per kg current weight per day for severely obese pregnant women (BMI >30).
40 kcal per kg current weight per day in pregnant women who are less than BMI 22.
Jovanovic-Peterson L, Peterson, CM. Nutritional management of the obese gestational diabetic woman. J Am CollNutr 1992; 11:246.
Consensus and hard data are lacking regarding how long diet therapy should be maintained before initiating pharmacologic treatment.
70% of the subjects with initial fasting plasma glucose less than 95 mg/dL achieved targeted levels of glycemia within 2 weeks of dietary management, but no significant improvement occurred thereafter
McFarland et al obstet gynecol 1999
Randomized trial glyburidevs insulin
404 GDMs FPG >95 but <140 mg/dl or 2- hr pp >120 on diet
Similar success of glucose control in both groups
Langer et al: NEJM 200:343:1134
9 countries, 25 centers, 23,325 patients
7 year study
Women were screened between 24-32weeks with fasting glucose, 1 hour and 2 hour post 75 gm glucose .
Medical caregivers were blinded to results except that exceeded pre defined cut offs[ 5.8 fasting, 11.1 post 75 gm glucose] and were then removed from the study.
Birth weight, maternal complications, operative delivery, insulin levels in newborn were studied.
Int J,Gynecology & Obstetrics. 2002,78, (1);69-77
Normalisation of this is possible by Insulin Analogues.
Moshe Hod et al.,
Studied insulin aspart in Type I diabetic patient
Randomized parallel group open label
Primary objective – Hypoglycemic attacks
Secondary objective – Analyze maternal/fetal outcome
- 8 point glucose profile
- Number of mild hypoglycemia
- cord blood insulin AB