Current controversies in the mechanisms and treatment of gestational diabetes

Abstract

Gestational diabetes mellitus (GDM) is a heterogeneous entity, including carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Insulin resistance and beta-cell dysfunction are thought to be major determinants of its development. Its pathomechanism in many ways resembles that of type 2 diabetes. There is an evolving body of evidence from the last decade presenting similarities between gestational diabetes and the metabolic (insulin resistance) syndrome. These new observations suggest that GDM might be an early manifestation of the metabolic syndrome. The desired treatment target of GDM is normoglycemia. It can be reached by dietary treatment; however, if it fails, maternal glycemic monitoring or combined fetal-maternal monitoring, or even insulin (if required) can help reach it. Multiple daily insulin regimens are becoming more widely accepted for the treatment of GDM. Insulin analogues, however, need some more evidence to support their usefulness and safety during pregnancy. The screening for GDM, the reclassification, regular care, and follow-up of these women after pregnancy are of the utmost importance to delay or prevent not only type 2 diabetes but cardiovascular complications as well.

Comparing twice- versus four-times daily insulin in mothers with gestational diabetes in Pakistan and its implications

“…This in turn resulted from an increase in the mean dose of insulin administered. Our findings are in agreement with those of others (24)(25)(26)(27) who found that administrating the four times daily regimen in pregnancy improved glycaemic control and perinatal outcomes without risk to the mother except for hypoglycaemia. However, this did not lead to severe hypoglycaemia.…”

A population-based screening for gestational diabetes mellitus in non-diabetic women in Bahrain

“…These new observations suggest that GDM might be an early manifestation of the metabolic syndrome. 9 Although glucose tolerance normalizes shortly after pregnancy with GDM in the majority of women, the risk of developing overt diabetes, especially type 2 diabetes is markedly increased. 10 Insulin resistance and beta cell function in Asian and Caucasian women are similar.…”

Proteomics reveals different pathological processes of adipose tissue, liver, and skeletal muscle under insulin resistance

“…Gestational diabetes mellitus (GDM) is regarded as the early stage of T2DM (Tamás & Kerényi, 2002), both of them have similar pathophysiological mechanisms (Saisho et al, 2010(Saisho et al, , 2013, especially IR. Studies showed that in GDM, differential proteins were mainly involved in the processes of inflammation, lipids and glucose metabolism, and oxidative stress, which was similar to the results of diabetes studies (Ma et al, 2016;Oliva, Barker, Rice, Bailey, & Lappas, 2013).…”