摘要
Women with a history of gestational diabetes should be screened during and after the postpartum period because of a high risk for developing type 2 diabetes mellitus.Although differences exist between guidelines practiced throughout various parts of the world,all recommend the use of cutoffs for fasting and/or postload plasma glucose to diagnose diabetes or prediabetes.The use of these glycemic parameters could be optimized when a trend is observed,rather than considering them as isolated values at various time points.As the presence of insulin resistance and betacell dysfunction start before glycemic changes areevident,the estimation of insulin sensitivity and beta-cell function by Homeostatic Model Assessment is suggested for women who have additional risk factors for diabetes,such as obesity.Disease-modifying lifestyle intervention should be the first-line strategy to prevent or delay the onset of diabetes in women with a history of gestational diabetes mellitus.Intensive lifestyle interventions are designed to decrease caloric intake and increase physical activity in order to reduce body weight and fat,which will in turn reduce insulin resistance.This article also reviews unique problems of postpartum women,which should be considered when designing and implementing an intervention.Innovative "out of the box" thinking is appreciated,as continued adherence to a program is a challenge to both the women and the health care personnel who deal with them.
Women with a history of gestational diabetes shouldbe screened during and after the postpartum periodbecause of a high risk for developing type 2 diabetesmellitus. Although differences exist between guidelinespracticed throughout various parts of the world, allrecommend the use of cutoffs for fasting and/or postloadplasma glucose to diagnose diabetes or prediabetes.The use of these glycemic parameters couldbe optimized when a trend is observed, rather thanconsidering them as isolated values at various timepoints. As the presence of insulin resistance and betacelldysfunction start before glycemic changes areevident, the estimation of insulin sensitivity and beta-cellfunction by Homeostatic Model Assessment is suggestedfor women who have additional risk factors for diabetes,such as obesity. Disease-modifying lifestyle interventionshould be the first-line strategy to prevent or delay theonset of diabetes in women with a history of gestationaldiabetes mellitus. Intensive lifestyle interventionsare designed to decrease caloric intake and increasephysical activity in order to reduce body weight and fat,which will in turn reduce insulin resistance. This articlealso reviews unique problems of postpartum women,which should be considered when designing andimplementing an intervention. Innovative ＂out of thebox＂ thinking is appreciated, as continued adherenceto a program is a challenge to both the women and thehealth care personnel who deal with them.
