Insulin therapy in women with pregestational type 2 diabetes and its relevance to maternal and neonatal complications

Gupta, Sunil; Gupta, Kavita; Gathe, Sachin; Bamhra, Parvindar; Gupta, Suman

doi:10.1007/s13410-016-0541-2

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…Government of India, in the recently published revised guidelines on diagnosis and management of GDM, has recommended target fasting blood glucose as less than 95 mg/dL and all 2-h post-prandial glucose levels as less than 120 mg/dL [99]. Women with pre-existing type 2 DM from central India have shown to have significantly higher post dinner blood glucose than post breakfast [100]. Thus, women on insulin therapy should do frequent testing including fasting, 2-h post breakfast, 2-h post lunch, and 2-h post dinner for insulin dose adjustment.…”

Section: Diabetes In Pregnancymentioning

confidence: 99%

RSSDI consensus on self-monitoring of blood glucose in types 1 and 2 diabetes mellitus in India

P¹,

Makkar

Kumar

et al. 2018

Int J Diabetes Dev Ctries

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Maintaining a good glycemic control is crucial in the management of diabetes mellitus (DM) as it is associated with the reduction in both macro and microvascular complications of the disease. Self-monitoring of blood glucose (SMBG), which provides the day-today blood glucose levels, is a simple and practical tool for maintaining a good glycemic control. Although SMBG is widely practiced in other countries, its use in India is very limited. Even when used, it is not carried out is a structured manner. There seems to be a lack of education about the purpose of SMBG and the correct process and schedule to be followed. This highlights the unmet need for country-specific SMBG recommendations. In order to fulfil this need, a panel of expert endocrinologists/ diabetologists came together under the aegis of Research Society for the Study of Diabetes in India (RSSDI). They reviewed the current literature, combined the evidences with their clinical knowledge and expertise, and developed consensus recommendations for SMBG practice in India. This document provides a comprehensive review of the current literature on SMBG and presents the recommendations made by the expert panel.

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Section: Diabetes In Pregnancymentioning

confidence: 99%

RSSDI consensus on self-monitoring of blood glucose in types 1 and 2 diabetes mellitus in India

P¹,

Makkar

Kumar

et al. 2018

Int J Diabetes Dev Ctries

Self Cite

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Insulin Use During Gestational and Pre-existing Diabetes in Pregnancy: A Systematic Review of Study Design

Castorino,

Osumili,

Lakiang

et al. 2024

Diabetes Ther

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Introduction Insulin is the first-line pharmacologic therapy for women with diabetes in pregnancy. However, conducting well-designed randomized clinical trials (RCTs) and achieving recommended glycemic targets remains a challenge for this unique population. This systematic literature review (SLR) aimed to understand the evidence for insulin use in pregnancy and the outcome metrics most often used to characterize its effect on glycemic, maternal and fetal outcomes in gestational diabetes mellitus (GDM) and in pregnant women with diabetes. Methods An SLR was conducted using electronic databases in Medline, EMBASE via Ovid platform, evidence-based medicine reviews (2010–2020) and conference proceedings (2018–2019). Studies were included if they assessed the effect of insulin treatment on glycemic, maternal or fetal outcomes in women with diabetes in pregnancy. Studies on any type of diabetes other than gestational or pre-existing diabetes as well as non-human studies were excluded. Results In women diagnosed with GDM or pre-existing diabetes, most studies compared treatment of insulin with metformin ( n = 35) followed by diet along with lifestyle intervention ( n = 24) and glibenclamide ( n = 12). Most studies reporting on glycemic outcomes compared insulin with metformin ( n = 22) and glibenclamide ( n = 4). Fasting blood glucose was the most reported clinical outcome of interest. Among the studies reporting maternal outcomes, method of delivery and delivery complications were most commonly reported. Large for gestational age, stillbirth and perinatal mortality were the most common fetal outcomes reported. Conclusion This SLR included a total of 108 clinical trials and observational studies with diverse populations and treatment arms. Outcomes varied across the studies, and a lack of consistent outcome measures to manage diabetes in pregnant women was observed. This elucidates a need for global consensus on study design and standardized clinical, maternal and fetal outcomes metrics. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-024-01541-6.

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Management of Gestational Diabetes Mellitus with Medical Nutrition Therapy

Salis¹,

Vora²,

Syed³

et al. 2021

Journal of Diabetology

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Gestational diabetes mellitus (GDM) also referred to as hyperglycemia during pregnancy is posing to be a big health concern for women and is emerging as a major public health problem in India. Early diagnosis and tight glycemic control during pregnancy play a pivotal role in improving pregnancy outcomes in women with GDM. Once diagnosis is made, lifestyle behavioral changes with medical nutrition therapy (MNT) and physical activity form the first choice of therapy for the management of GDM. Failure to meet glycemic goals with these requires the addition of medication/insulin. Regular blood glucose monitoring and record keeping must be encouraged to improve adherence and review treatment efficacy. MNT for GDM is defined as a “carbohydrate-controlled” meal plan that provides adequate nutrition along with appropriate weight gain and fetal well-being to meet increased requirements of energy, protein, and micronutrients, achieve normoglycemia, and prevent nutritional ketosis. Choosing nutrient-dense carbohydrate sources which are low to moderate in glycemic index and glycemic load with focus on the correct amount and distribution of carbohydrates at meals helps control postprandial glucose excursions which is the biggest challenge in GDM. Blood glucose levels can be difficult to control in the morning due to increased insulin resistance secondary to dawn phenomenon seen in women with GDM. Splitting meals at breakfast has shown to improve post-breakfast blood glucose levels. This article is a comprehensive review of guidelines and scientific literature for the dietary management of GDM aimed at achieving normoglycemia, ensuring fetal and maternal wellbeing, and preventing adverse outcomes in pregnancy. The literature has been retrieved from various databases such as “Google Scholar,” “PubMed,” and “Cochrane Database of Systematic Reviews” using relevant keywords related to the topics discussed in this manuscript.

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Insulin therapy in women with pregestational type 2 diabetes and its relevance to maternal and neonatal complications

Cited by 3 publications

References 15 publications

RSSDI consensus on self-monitoring of blood glucose in types 1 and 2 diabetes mellitus in India

RSSDI consensus on self-monitoring of blood glucose in types 1 and 2 diabetes mellitus in India

Insulin Use During Gestational and Pre-existing Diabetes in Pregnancy: A Systematic Review of Study Design

Management of Gestational Diabetes Mellitus with Medical Nutrition Therapy

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