Gestational diabetes from A to Z

Gestational diabetes mellitus(GDM) is defined as any degree of hyperglycaemia that is recognized for the first time during pregnancy. This definition includes cases of undiagnosed type 2 diabetes mellitus(T2 DM) identified early in pregnancy and true GDM which develops later. GDM constitutes a greater impact on diabetes epidemic as it carries a major risk of developing T2 DM to the mother and foetus later in life. In addition, GDM has also been linked with cardiometabolic risk factors such as lipid abnormalities, hypertensive disorders and hyperinsulinemia. These might result in later development of cardiovascular disease and metabolic syndrome. The understanding of the different risk factors, the pathophysiological mechanisms and the genetic factors of GDM, will help us to identify the women at risk, to develop effective preventive measures and to provide adequate management of the disease. Clinical trials have shown that T2 DM can be prevented in women with prior GDM, by intensive lifestyle modification and by using pioglitazone and metformin. However, a matter of controversy surrounding both screening and management of GDM continues to emerge, despite several recent welldesigned clinical trials tackling these issues. The aim of this manuscript is to critically review GDM in a detailed and comprehensive manner, in order to provide a scientific analysis and updated write-up of different related aspects.

Management of gestational diabetes mellitus via nutritional interventions:The relevance of gastric emptying

Gestational diabetes mellitus(GDM)represents one of the most common medical complications of pregnancy and is important to the well-being of both mothers and offspring in the short and long term.Lifestyle intervention remains the mainstay for the management of GDM.The efficacy of nutritional approaches(e.g.calorie restriction and small frequent meals)to improving the maternal-neonatal outcomes of GDM was attested to by Chinese population data,discussed in two articles in recent issues of this journal.However,a specific focus on the relevance of postprandial glycaemic control was lacking.Postprandial rather than fasting hyperglycaemia often represents the predominant manifestation of disordered glucose homeostasis in Chinese women with GDM.There is now increasing appreciation that the rate of gastric emptying,which controls the delivery of nutrients for digestion and absorption in the small intestine,is a key determinant of postprandial glycaemia in both health,type 1 and 2 diabetes.It remains to be established whether gastric emptying is abnormally rapid in GDM,particularly among Chinese women,thus contributing to a predisposition to postprandial hyperglycaemia,and if so,how this influences the therapeutic response to nutritional interventions.It is essential that we understand the role of gastric emptying in the regulation of postprandial glycaemia during pregnancy and the potential for its modulation by nutritional strategies in order to improve postprandial glycaemic control in GDM.

Tailored nutritional interventions: A precision approach to managing gestational diabetes mellitus

Gestational diabetes mellitus(GDM)is a risk to maternal-fetal health due to uncertain diagnostic criteria and treatment options.Luo's study demonstrated the efficacy of customized nutritional therapies in controlling GDM.Tailored strategies led to significant body weight loss,improved glucolipid metabolism,and fewer prenatal and newborn problems.This holistic approach,which emphasizes the notion of’chrononutrition’,takes into account optimal meal timing that is in sync with circadian rhythms,as well as enhanced sleep hygiene.Implementing tailored dietary therapy,managing meal timing,and ensuring appropriate sleep may improve results for women with GDM,opening up a possible avenue for multi-center trials.

Guide to the Diet and Health of the Patients with Gestational Diabetes Mellitus

Gestational diabetes mellitus is one of the important complications occurring in women during the perinatal period and also can give rise to the adverse consequences of pregnancy, so that the possibilities for the mother and the child to suffer diabetes mellitus T2 are significantly increased. Diet control is the primary method for the treatment of gestational diabetes mellitus, and good health guide to diet can help control blood sugar and ensure the pregnant women to obtain sufficient blood supply so that the occurrence of adverse consequences is reduced.

Pregnant Women with Diabetes under the Novel COVID-19 Pneumonia Epidemic Home Protection and Diet and Exercise Management

Under the epidemic situation of novel COVID-19 pneumonia, pregnant women belong to the susceptible population, and their physiological and psychological conditions are particularly worthy of attention. Diabetes patients during pregnancy may have a variety of complications, which can have a serious adverse impact on their own and fetal health. This article elaborates on home protection and diet and exercise guidance for pregnant women with diabetes in order to provide guidance for pregnant women with diabetes in a special period, and further prevent and control the pneumonia epidemic caused by novel COVID-19 infection in pregnant women.

Gestational diabetes mellitus: Challenges for different ethnic groups

Ethnicity is defined as"belonging to a social groupthat has a common national or cultural tradition".Membership of certain ethnic groups has long been associated with increased risk of gestational diabetes mellitus(GDM).Studies that examined ethnic differences amongst women with GDM were often conducted in western countries where women from various ethnic backgrounds were represented.The prevalence of GDM appears to be particularly high among women from South Asia and South East Asia,compared to Caucasian,African-American and Hispanic communities.For some,but not all ethnic groups,the body mass index is a risk factor for the development of GDM.Even within a particular ethnic group,those who were born in their native countries have a different risk profile for GDM compared to those born in western countries.In terms of treatment,medical nutrition therapy(MNT)plays a key role in the management of GDM and the prescription of MNT should be culturally sensitive.Limited studies have shown that women who live in an English-speaking country but predominantly speak a language other than English,have lower rates of dietary understanding compared with their English speaking counterparts,and this may affect compliance to therapy.Insulin therapy also plays an important role and there appears to be variation as to the progression of women who progress to requiring insulin among different ethnicities.As for peri-natal outcomes,women from Pacific Islander countries have higher rates of macrosomia,while women from Chinese backgrounds had lower adverse pregnancy outcomes.From a maternal outcome point of view,pregnant women from Asia with GDM have a higher incidence of abnormal glucose tolerance test results post-partum and hence a higher risk of future development of type2 diabetes mellitus.On the other hand,women from Hispanic or African-American backgrounds with GDM are more likely to develop hypertension post-partum.This review highlights the fact that management needs to be individualised and the clinician should be mindful of the impact that differences in ethnicity may have on the clinical characteristics and pregnancy outcomes inwomen affected by GDM,particularly those living in Western countries.Understanding these differences is critical in the delivery of optimal antenatal care for women from diverse ethnic backgrounds.

Participant attrition and perinatal outcomes in prenatal vitamin Dsupplemented gestational diabetes mellitus patients in Asia: A metaanalysis

BACKGROUND The role of vitamin D supplementation in gestational diabetes mellitus(GDM)patients is unclear.AIM To determine the burden and risk of post-randomization GDM patient attrition from vitamin D-supplemented arms of randomized controlled trials(RCTs).The auxiliary aim was to compare the effects of nutritional supplements on their fasting blood glucose(FPG)levels and perinatal outcomes.METHODS RCTs were searched in the PubMed,Embase,and Scopus databases.Randomeffect prevalence and pairwise meta-analysis were performed for the primary objective.The auxiliary aim was to compare the effects of nutritional supplements on their fasting blood glucose(FPG)levels and perinatal outcomes.Fixed-effect network meta-analyses were undertaken for the secondary goals.All analyses were performed using Stata software,and statistical significance was determined at P<0.05.RESULTS Thirteen RCTs from Iran and China were reviewed.The participant attrition burden in vitamin D recipients was 6%[95%confidence interval(CI):0.03,0.10],and its risk did not vary from non-recipients.Vitamin D and calcium co-supplementation reduced the cesarean section incidence in GDM patients[risk ratio(RR):0.37;95%CI:0.18,0.74].The hyperbilirubinemia or hospitalization risk in their newborns decreased with vitamin D supplementation(RR:0.47;95%CI:0.27,0.83)and co-supplementation with calcium(RR:0.35;95%CI:0.16,0.77)or omega3 fatty acids(RR:0.25;95%CI:0.08,0.77).Vitamin D and probiotics co-supplementation decreased newborn hyperbilirubinemia risk(RR:0.28;95%CI:0.09,0.91).FPG levels and macrosomia risk did not vary across interventions.CONCLUSION In RCTs,vitamin D supplementation or co-supplementation in GDM patients showed a low participant attrition burden and low risk of cesarean section,newborn hyperbilirubinemia,and newborn hospitalization.

Intermittent energy restriction in type 2 diabetes: A short discussion of medication management

AIM To discuss type 2 diabetes mellitus(T2DM) medication changes required during the popular 5:2 intermittent energy restriction(IER) diet. METHODS A search was conducted in MEDLINE, EMBASE, AMED, CINAHL and Cochrane library for original research articles investigating the use of very low calorie diets(VLCD) in people with T2 DM. The search terms used included "VLCD" or "very low energy diet" or "very low energy restriction" or "IER" or "intermittent fasting" or "calorie restriction" or "diabetes mellitus type 2" and "type 2 diabetes". Reference lists of selected articles were also screened for relevant publications. Only research articles written in English, which also included an explanation of medication changes were included. A recent pilot trial using the 5:2 IER method, conducted by our research group, will also be summarized.RESULTS A total of 8 studies were found that investigated the use of VLCD in T2 DM and discussed medication management. Overall these studies indicate that the use of a VLCD for people with T2 DM usually require the cessation of medication to prevent hypoglycemia. Therefore, the 5:2 IER method will also require medication changes, but as seen in our pilot trial, may not require total cessation of medication, rather a cessation on the 2 IER days only. CONCLUSION Guidelines outlined here can be used in the initial stages of a 2-d IER diet, but extensive blood glucose monitoring is still required to make the necessary individual reductions to medications in response to weight loss.

Managing Vogt–Koyanagi–Harada disease during pregnancy with steroid pulse therapy:A case report

BACKGROUND High-dose steroid administration is a common initial therapeutic approach for Vogt–Koyanagi–Harada disease(VKH).Nonetheless,administering substantial doses of steroids to pregnant women necessitates meticulous consideration due to the potential impacts on the mother and fetus.We present a case wherein steroid pulse therapy was administered to a patient who developed VKH during the late stages of pregnancy.CASE SUMMARY The patient was a 26-year-old nulliparous woman.At 33 weeks and 1 day of her pregnancy,she experienced a decline in visual acuity and noticed metamorphopsia in her left eye.Examination revealed bilateral serous retinal detachment,leading to VKH diagnosis.A collaborative effort involving the departments of ophthalmology,internal medicine,and neonatology was initiated.Steroid pulse therapy was administered at 34 weeks and 1 day of pregnancy under hospital supervision.Complications,such as threatened preterm labor and gestational diabetes,emerged,necessitating the initiation of oral ritodrine hydrochloride and insulin therapy.Then,serous retinal detachment was resolved,and visual acuity was restored.Labor pains initiated 32 days post-initiation of steroid pulse therapy(at 38 weeks and 4 days of gestation),culminating in a normal delivery.Mother and newborn experienced an uneventful puerperal course and were discharged from the hospital on the 5th day following delivery.CONCLUSION VKH management in pregnancy requires multidisciplinary coordination,emphasizing collaboration with ophthalmologists and specialists in internal medicine and neonatology.

Effect of Nutritional Diet Therapy in Pediatric Diabetic Patients

Objective:To analyze the effect nutritional diet therapy in pediatric diabetic patients.Methods:The study object was 60 cases of children with diabetes,which were divided into groups and treated separately according to the time of admission,and the treatment effects were compared.Results:After treatment,the glycated hemoglobin level,fasting blood glucose level,blood glucose level at 2 hours after meal,serum calcium level,transferrin level,albumin level,prealbumin level,hemoglobin level,the height,weight,and head circumference of the experimental group were better than those of the control group,and there were significant differences between the groups(P<0.05).Conclusion:The application of nutritional diet therapy in the treatment of pediatric diabetic patients can significantly improve blood glucose levels,nutritional indicators and physical indicators of patients.

基于古籍挖掘的糖尿病中医食疗方调制规律研究

目的 探究糖尿病中医食疗方的调制规律,为糖尿病的临床辨证施食和食疗研究提供参考。方法 收集《中医方剂大辞典》《中医食疗方全录》《中国药膳大辞典》三本纸版古籍中收载的糖尿病食疗方,提取方名、组成、剂型等信息,应用SPSS 26.0进行频数分析及聚类分析,采用SPSS Modeler 18.0开展食物配伍关联分析。结果 共纳入食疗方264首,涉及191种食物。古代糖尿病中医食疗方多用补虚类(47.91%)食药物质及保健食品药材,清热类(11.84%)次之;多以平性(36.65%)、温性(31.41%)为主;味多甘味(55.38%);归经则以脾经(18.99%)、肾经(17.51%)、胃经(16.46%)、肺经(15.40%)居多;汤剂为常见剂型(32.58%);五谷类食物使用较多(25.25%);其主治证型以气阴亏虚(32.07%)为主。结论 古代医家重视由调治中焦入手,灵活应用中医食疗方调治糖尿病,讲究补虚辅以清热利湿,善于理气和中祛湿化浊,妙用“温”品,遵循辨证原则,选材多味,组方多样,为临床进行中医食疗干预糖尿病提供了有益借鉴与思路启发。

基于运动饮食血糖控制对高龄产妇妊娠期糖尿病患者妊娠结局的影响及并发症分析

目的评价基于运动饮食血糖控制在高龄产妇妊娠期糖尿病患者中的应用效果。方法选择2019年1月—2022年6月山东省寿光市人民医院收治的140例高龄产妇妊娠期糖尿病患者为研究对象,按随机数表法分成两组(对照组和观察组),对照组70例接受常规孕期保健,观察组70例在对照组基础上接受运动饮食指导,比较两组的血糖水平、不良妊娠结局、新生儿不良结局。结果观察组空腹血糖、餐后2 h血糖、糖化血红蛋白、不良妊娠结局总发生率、新生儿不良结局总发生率均低于对照组,差异有统计学意义(P均<0.05)。结论在高龄产妇妊娠期糖尿病患者中,基于运动饮食血糖控制可有效降低患者血糖水平,且可改善患者妊娠结局以及新生儿结局。

健脾祛湿食疗联合门冬胰岛素治疗儿童1型糖尿病痰湿体质的价值

目的探讨健脾祛湿食疗联合门冬胰岛素治疗儿童1型糖尿病痰湿体质的价值。方法选择2021年7月—2023年7月淄博市妇幼保健院接收的98例儿童1型糖尿病痰湿体质患儿为研究对象,按治疗方法的不同分为两组,各49例,对照组采取门冬胰岛素治疗,观察组采取健脾祛湿食疗联合门冬胰岛素治疗,比较两组治疗效果、血糖水平(空腹血糖、餐后2 h血糖、糖化血红蛋白)、血脂水平(总胆固醇、甘油三酯)。结果观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,观察组血糖水平低于对照组,差异有统计学意义(P均<0.05)。治疗后,观察组血脂水平低于对照组,差异有统计学意义(P均<0.05)。结论1型糖尿病痰湿体质患儿采取健脾祛湿食疗联合门冬胰岛素治疗可进一步控制血糖水平,消退不良症状,调节血脂水平。

饮食营养健康管理对妊娠期糖尿病患者的产前血糖水平、自我管理行为的影响

目的探讨妊娠期糖尿病患者实施饮食营养健康管理对其血糖水平、自我管理行为的影响。方法回顾性选取2021年1月—2023年6月枣庄市妇幼保健院收治的86例妊娠期糖尿病患者的临床资料,按照护理方式的不同,分为观察组与对照组,各43例。对照组患者实施常规护理干预,观察组患者在对照组基础上进行饮食营养健康管理。干预后比较两组患者自我管理能力、血糖水平。结果干预后,观察组患者各维度糖尿病自我管理行为量表评分均高于对照组,差异有统计学意义(P均<0.05)。观察组餐后2 h血糖、空腹血糖、糖化血红蛋白水平低于对照组,差异有统计学意义(P均<0.05)。结论饮食营养健康管理用于妊娠期糖尿病患者护理中可改善妊娠期糖尿病患者自我管理行为,从而提升血糖控制效果。

门冬胰岛素结合个体化饮食及运动指导控制GDM血糖效果

目的:观察门冬胰岛素结合个体化饮食及运动指导控制妊娠期糖尿病(GDM)孕妇血糖效果。方法:纳入2020年1月-2023年3月本院收治的GDM孕妇101例,随机数字表法分为观察组(50例)与对照组(51例),对照组采取常规胰岛素治疗,观察组采取门冬胰岛素结合个体化饮食及运动指导控制血糖,观察治疗前及治疗3个月后孕妇空腹血糖(FBG)及餐后2h血糖(2hPBC)、糖化血红蛋白(HbAlc)等血糖指标,空腹胰岛素(FINS)及稳态模型胰岛β细胞功能指数(HOMA-β)、稳态模型胰岛素抵抗指数(HOMA-IR)等胰岛功能指标,超氧化物歧化酶(SOD)与活性氧(ROS)水平、谷胱甘肽过氧化物酶(GSH-Px)等氧化应激指标变化,治疗依从性及治疗满意率,并观察不良结局发生率。结果:治疗3个月后观察组血糖FBG(4.75±0.46mmol/L)、2hPBC(5.84±0.60mmol/L)、HbAlc(6.05±0.41)%均低于对照组(5.61±0.70mmol/L、5.84±0.60mmol/L、6.47%±0.44%),胰岛功能指标、氧化应激指标均优于对照组,观察组依从率(98.0%)及治疗满意率(96.0%)均高于对照组(84.3%、82.4%),产妇不良结局(2.0%)及新生儿不良结局(4.0%)均低于对照组(13.7%、15.7%)(均P<0.05)。结论:门冬胰岛素结合个体化饮食及运动指导可较好帮助患者控制血糖水平,改善胰岛功能,患者依从性更好、满意率高,降低了不良结局发生。

度拉糖肽注射液配合低碳水化合物早餐饮食疗法对老年糖尿病患者糖脂代谢紊乱的影响

目的:探究度拉糖肽注射液配合低碳水化合物早餐饮食疗法对老年糖尿病患者糖脂代谢紊乱的影响。方法:采用随机数字表法将84例2021年1月—2023年1月来单县中心医院内分泌科就诊的老年糖尿病患者分为对照组(42例)和试验组(42例),两组均予以常规药物治疗,在此基础上,对照组予以低碳水化合物早餐饮食疗法治疗,试验组则在对照组治疗基础上加用度拉糖肽注射液治疗,疗程均为3个月,对比两组治疗前后糖代谢水平、血脂指标水平、体重指数(BMI)、胰岛素水平。结果:经治疗后,两组空腹血糖(FPG)、餐后2 h血糖(2 h PG)及糖化血红蛋白(HbA1c)均较于治疗前明显下降,且试验组均低于对照组(P<0.05);试验组低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、甘油三酯(TG)均比对照组低(P<0.05),而高密度脂蛋白胆固醇(HDL-C)比对照组高(P<0.05);试验组BMI、空腹胰岛素(FINS)、餐后2 h胰岛素均低于对照组(P<0.05)。结论:采用度拉糖肽注射液配合低碳水化合物早餐饮食疗法对老年糖尿病治疗具有较好的效果,能够有效改善糖脂代谢异常和胰岛素功能,降低血糖与体质量。

综合性早期饮食宣教指导对高龄妊娠期糖尿病孕产妇的效果

目的观察综合性早期饮食宣教指导对高龄妊娠期糖尿病孕产妇的效果及对妊娠结局的影响效果。方法选取2021年7月至2022年6月收治于宿迁市第一人民医院的高龄妊娠期糖尿病患者90例为研究对象。采用随机数字表法将90例高龄妊娠期糖尿病患者分为试验组和对照组,每组45例。对照组遵循妊娠期糖尿病常规宣教法施护,试验组在此基础之上引入综合性早期饮食宣教指导干预机制,对2组干预后的各观察指标进行比较。结果试验组高龄妊娠期糖尿病患者饮食控制认知度评分、饮食控制依从性评分与对照组比较,差异均有统计学意义(P<0.05),试验组血糖控制成效测评指标优于对照组,不良妊娠结局率低于对照组(P<0.05)。结论采用综合性早期饮食宣教指导对高龄妊娠期糖尿病孕产妇施加干预,利于其饮食控制认知度、依从度的提升,可取得较佳血糖控制成效、减低不良妊娠结局概率。

基于ADOPT问题解决模式的护理干预结合饮食疗法对糖尿病合并前列腺增生术后患者饮食行为及康复情况的影响

目的探讨基于ADOPT问题解决模式的护理干预结合饮食疗法对糖尿病合并前列腺增生术后患者饮食行为及康复情况的影响。方法选取2020年3月至2022年4月收治的86例糖尿病合并前列腺增生术后患者为研究对象,以随机数字表法将其分为对照组与观察组,各43例。对照组采用常规护理干预,观察组在对照组基础上给予基于ADOPT问题解决模式的护理干预结合饮食疗法。比较两组的干预效果。结果干预后,观察组的遵医饮食行为、日常饮食管理行为、饮食依从性态度评分高于对照组(P<0.05)。干预后,观察组的空腹血糖(FBG)、餐后2 h血糖(2 h PG)、CD68、碱性成纤维细胞生长因子(bFGF)水平低于对照组(P<0.05)。观察组的术后并发症总发生率低于对照组(P<0.05)。结论基于ADOPT问题解决模式的护理干预联合饮食疗法不仅能够改善糖尿病合并前列腺增生术后患者的饮食行为,还能促进机体康复,减少术后并发症发生风险,值得推广。

精细化定量饮食联合运动制订在妊娠糖尿病患者中的应用价值

目的:分析精细化定量饮食联合运动制订在妊娠糖尿病患者中的应用效果。方法:选取2021年8月—2023年2月泰安市妇幼保健院收治的妊娠糖尿病患者82例作为研究对象,随机分为观察组和对照组,各41例。对照组给予常规饮食、运动护理,观察组给予精细化定量饮食联合运动制订。比较两组护理效果。结果:护理后,两组空腹血糖、餐后2 h血糖、糖化血红蛋白,甘油三酯、总胆固醇、低密度脂蛋白胆固醇水平及胰岛素抵抗指数低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05);两组高密度脂蛋白胆固醇、胰岛素分泌指数、空腹胰岛素水平高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组不良妊娠结局发生率低于对照组,差异有统计学意义(P=0.011)。结论:精细化定量饮食联合运动制订可降低妊娠糖尿病患者血糖、血脂水平,改善胰岛功能和妊娠结局。

医学营养治疗在妊娠期糖尿病患者中的运用价值评估分析

目的 回顾性分析在妊娠期糖尿病患者中采取医学营养治疗的效果。方法 回顾性分析2021年10月—2023年9月上海交通大学医学院苏州九龙医院诊治90例妊娠期糖尿病患者的临床资料,根据不同治疗方法,将其分成研究组(常规治疗+医学营养治疗)和参比组(常规治疗),各45例,比较两组血糖水平、胰岛功能、血脂指标、妊娠结局。结果 治疗后,研究组血糖水平低于参比组,差异有统计学意义(P<0.05);治疗后,研究组胰岛功能强于参比组,差异有统计学意义(P<0.05);研究组血脂指标优于参比组,差异有统计学意义(P<0.05);研究组不良妊娠结局发生率低于参比组,差异有统计学意义(P<0.05)。结论 在妊娠期糖尿病患者中采取医学营养治疗,可以改善血糖和血脂水平,促进胰岛功能恢复,优化妊娠结局。