Gestational Diabetes Mellitus. At What Time Should the Postprandial Glucose Level be Monitored?

Moses, Robert G.; Luca, Elizabeths M; Knights, Sallyanne

doi:10.1111/j.1479-828x.1999.tb03132.x

Cited by 37 publications

(13 citation statements)

References 9 publications

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“…There is also no consensus as to the optimal timing of the postprandial test [15]. Traditionally, in the guidelines for care of nonpregnant diabetic patients, glucose monitoring 2 hours after eating has been recommended because of fear of hypoglycemia due to the peak action of human regular insulin.…”

Section: Importance Of Monitoring Postprandial Glucose Levels In Gestmentioning

confidence: 99%

Continuous glucose monitoring during pregnancy complicated by gestational diabetes mellitus

Jovanovič

2001

Curr Diab Rep

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Postprandial glucose has been reported to be the best predictor of neonatal macrosomia. Therefore, self-blood glucose monitoring (SBGM) protocols for diabetic pregnant women stress the importance of measuring blood glucose after meals. However, there is controversy in the literature. Traditionally, glucose monitoring has been prescribed at 2 hours after eating to coincide with the times a patient is at increased risk of hypoglycemia. Human regular insulin peaks at 2 to 3 hours after injection; thus, checking blood glucose at the 2-hour point is a relic of strategies to prevent hypoglycemia. In pregnancy, the emphasis has been on measuring during times when blood glucose levels are highest. One hour after the start of the meal has been shown to be the time of peak postprandial response in 90% of pregnant woman. Because glucose excursions may reach their maximum at varying times, based on the size and number of meals ingested, SBGM alone may not capture the full extent of total daily postprandial hyperglycemia. Because intermittent blood glucose monitoring underestimates the number of hyperglycemic events, a more accurate determination of postprandial glucose levels is necessary to decrease the risk of macrosomia in gestational diabetes mellitus. Continuous glucose monitoring may facilitate the detection of all postprandial peaks, including those due to unscheduled meals, and may provide an opportunity for better intervention by providing the complete glucose profile.

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Section: Importance Of Monitoring Postprandial Glucose Levels In Gestmentioning

confidence: 99%

Continuous glucose monitoring during pregnancy complicated by gestational diabetes mellitus

Jovanovič

2001

Curr Diab Rep

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“…Because the peak postprandial glucose concentration is 1 h after eating (11), a rapid-acting insulin analog that reaches peak concentration at about 1 h after injection would be ideal. Data on nonpregnant diabetic patients document that the rapid-acting insulin analog, insulin aspart, peaks at 40 to 60 min after injection and thus can be used to blunt the peak postprandial glucose concentrations (15). Before insulin aspart can be prescribed in pregnancy, the safety and efficacy of this insulin analog will need to be studied.…”

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confidence: 99%

Comparison of an Insulin Analog, Insulin Aspart, and Regular Human Insulin With No Insulin in Gestational Diabetes Mellitus

et al. 2003

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OBJECTIVE -To assess the short-term efficacy of insulin aspart in comparison with regular human insulin in women with gestational diabetes mellitus (GDM) during standardized meal tests.RESEARCH DESIGN AND METHODS -The study included 15 women with GDM who had inadequate diabetes control with diet alone. On 3 consecutive days, breakfast meal tests were performed-the first with no exogenous insulin and the other two after the injection of either regular insulin or insulin aspart.RESULTS -The peak insulin concentration was higher and the peak glucose and C-peptide concentrations were lower with both insulin preparations than with no exogenous insulin. Glucose areas under the curve above baseline were significantly lower with insulin aspart (180-min area, 7.1 mg ⅐ h ⅐ dl -1 ; P ϭ 0.018), but not with regular insulin (30.2 mg ⅐ h ⅐ dl -1 ; P ϭ 0.997), than with no insulin (29.4 mg ⅐ h ⅐ dl -1 ).CONCLUSIONS -This study demonstrates that effective postprandial glycemic control in women with GDM who required insulin was brought about by insulin aspart through higher insulin peak and lower demand on endogenous insulin secretion.

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“…Assessment of blood glucose can be undertaken at either 1 hour or 2 hours postprandially, but no study to date has demonstrated the superiority of either approach (24)(25)(26). Controlled trials to identify ideal glycemic targets have not been performed.…”

Section: How Should Blood Glucose Be Monitored In a Woman With Gdm?mentioning

confidence: 99%

Practice Bulletin No. 137

2013

Obstetrics &Amp; Gynecology

535

258

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Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. Debate continues to surround both the diagnosis and treatment of GDM despite several recent large-scale studies addressing these issues. The purpose of this document is to 1) provide a brief overview of the understanding of GDM, 2) provide management guidelines that have been validated by appropriately conducted clinical research, and 3) identify gaps in current knowledge toward which future research can be directed.

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Gestational Diabetes Mellitus. At What Time Should the Postprandial Glucose Level be Monitored?

Abstract: For women with GDM, monitoring either 1 hour or 2 hours postprandially led to similar outcomes. This would suggest that the ADIPS recommendations are equivalent and therefore women can choose the most convenient time for their postprandial monitoring.

Cited by 37 publications

References 9 publications

Continuous glucose monitoring during pregnancy complicated by gestational diabetes mellitus

Continuous glucose monitoring during pregnancy complicated by gestational diabetes mellitus

Comparison of an Insulin Analog, Insulin Aspart, and Regular Human Insulin With No Insulin in Gestational Diabetes Mellitus

Practice Bulletin No. 137

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