Il n'y a pas de réel consensus concernant l'approche nutritionnelle idéale à recommander en cas de diabète gestationnel (DG). Une réduction des quantités de glucides (low-carb) est fréquemment mise en avant, alors que de nombreuses études n'y retrouvent pas d'effets bénéfiques notables. Toutefois, selon des méta-analyses récentes, une alimentation à index glycémique (IG) bas a des effets bénéfiques pour la mère et l'enfant. Même si la valeur clinique et pratique de l'IG fait encore l'objet d'études, cela semble être l'approche la plus appropriée en cas de DG. En complément, les fibres dites « solubles » pourraient avoir un impact métabolique favorable dans le court délai imparti par la grossesse. Plus d'évidences sur l'impact de ces approches nutritionnelles à court et à long termes pour la mère et l'enfant sont indispensables. What is the place of a low carbohydrate or low glycemic index diet in gestational diabetes treatment?There is no real consensus on the ideal nutritional approach to recommend for gestational diabetes (GDM) treatment. A carbo hydrates reduction (lowcarb) is frequently suggested, although many studies have not found any consistent beneficial effects. On the other hand, according to recent metaanalyses, a low glycemic index (GI) diet would have favorable effects for the mother and the child. Although the clinical and practical value of GI is still being studied, a low GI diet seems to be the most appropriate approach in GDM. In addition, soluble fibers may have a beneficial metabolic impact in the short time of pregnancy. More evidence on the impact of these nutritional approaches in the short and long term for mother and child is needed. Impact et mesure des cétonesUne alimentation low-carb durant la grossesse pourrait favoriser l'augmentation des cétones, avec de possibles complications obstétricales associées. Peu d'études ont évalué l'impact
BackgroundThe COVID-19 pandemic has been associated with worsened metabolic and mental health in the general and perinatal population. The postpartum is a critical moment regarding these outcomes particularly in women with gestational diabetes mellitus (GDM). We investigated the cardio-metabolic and mental health outcomes before and during the pandemic in this population.MethodsThis cohort study included 418 women with GDM, recruited during two distinct periods. This included 180 women exposed to the pandemic (E+) and recruited between May 2020-April 2021 and 238 women who were not exposed to the pandemic during their postpartum period (attended a year before=non-exposed (E-)) and recruited between January-December 2019. Among the E+, a nested-subcohort of 120 women were exposed both during pregnancy and postpartum. During the pandemic, we adopted a hybrid follow-up of women that consisted of in-person consultations, regular contact via phone calls (35%), sent recorded exercise guide to patients to follow at home and linked to our website. We specifically focused on maintaining motivation and keeping a strong focus on healthy lifestyle behaviors. Obstetric, neonatal, cardio-metabolic and mental health outcomes were assessed during pregnancy and postpartum.ResultsThe pandemic was not associated with worsened weight, weight retention, glucose tolerance, metabolic syndrome, well-being or depression in the postpartum with the exception of a minimally increased HbA1c, diastolic blood pressure and lower emotional eating scores in E+ women (all p ≤ 0.046). In the nested subcohort, E+ women had a slightly increased HbA1c at the first GDM visit and a higher need for glucose-lowering medication (both p ≤ 0.014), but HbA1c at the end of pregnancy and other cardio-metabolic, mental health, obstetric and neonatal outcomes during pregnancy were similar.ConclusionsThe pandemic was not associated with any clinically relevant worsening of cardio-metabolic, mental health, obstetrical and neonatal outcomes in our GDM cohort. This was possibly due to a continued hybrid follow-up, and the partial lockdown in Switzerland.
Traitement par pompe à insuline : pour qui et comment le mettre en place en ambulatoire ? L'insulinothérapie par pompe existe depuis plus de 40 ans et permet une délivrance plus flexible de l'insuline. À ce jour, près de 25 % des patients diabétiques de type 1 ont choisi cette option thérapeutique. Depuis quelques années, elle est aussi proposée aux patients diabétiques de type 2 insulino-requérants. Le choix de la pompe à insuline repose sur son indication, la préférence du patient, son style de vie et ses connaissances de la maladie. Un risque de survenue d'acidocétose en cas d'interruption de la délivrance d'insuline existe. Sa mise en place nécessite donc une équipe de soins interdisciplinaire spécialisée et disponible en cas d'urgence. Insulin pump treatment : For whom and how to set it up on an outpatient ?Pump therapy has existed for over 40 years and provides a more flexible delivery of insulin. To date, almost 25 % of type 1 diabetic patients have chosen this therapeutic option. In recent years, it has also been offered to patients with type 2 insulin-requiring diabetes. The choice of insulin pump is based on its indication, the patient's preference, lifestyle and knowledge of the disease. A risk of developing ketoacidosis in case of interruption of insulin delivery exists. Its implementation therefore requires a specialized interdisciplinary care team available in case of emergency.
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