Clinical impact of women with gestational diabetes mellitus by the new consensus criteria: two year experience in a single institution in Japan
Clinical impact of women with gestational diabetes mellitus by the new consensus criteria: two year experience in a single institution in Japan
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DOI：
10.1507/endocrj.ej13-0496
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发表时间：
2014-04-01
影响因子：
2
通讯作者：
Yoshimura, Yasunori
中科院分区：
文献类型：
--
作者：
Ikenoue, Satoru;Miyakoshi, Kei;Yoshimura, Yasunori
由于实施新标准的卫生保健协会数量仍然有限，因此，根据真实的经验，关于妊娠期糖尿病（GDM）的围产期数据的信息非常缺乏。本研究的目的是探讨围产期的新标准定义的GDM的特点。我们回顾了995名单胎妊娠妇女，她们接受了GDM筛查，随后进行了诊断性口服葡萄糖耐量试验（OGTT）。所有发现患有GDM的妇女都进行了血糖测量的自我监测以及饮食管理。当饮食治疗未达到血糖目标时，开始胰岛素治疗。在995名女性中，141名患有GDM（14.2%）：104名患有1个异常OGTT值，27名患有2个异常OGTT值，10名患有3个异常OGTT值。有2个或3个OGTT值异常（2/3-AV）的妇女比有1个OGTT值异常（1-AV）的妇女更需要胰岛素治疗（70.3%vs23.1%，P < 0.0001）。校正年龄、妊娠前超重、诊断时孕周后，1-AV女性患者的一级糖尿病家族史与胰岛素治疗的实施相关（校正比值比3.9; 95%置信区间1.7-9.2; P = 0.001）。当比较糖耐量正常和GDM妇女的围产期结局时，两组之间的胎儿生长和妊娠高血压的发生率相当。我们的数据表明，IADPSG定义的1-AV GDM显示出不太严重的葡萄糖耐受不良，但当存在一级糖尿病家族史时，可能存在需要胰岛素的风险。
There is a paucity of information on perinatal data regarding gestational diabetes mellitus (GDM) by the new criteria from a real experience because the number of health care associations implementing the new criteria is still limited. The aim of this study is to investigate perinatal features of the new criteria-defined GDM. We reviewed a total of 995 women with singleton pregnancy that underwent GDM screening followed by a diagnostic oral glucose tolerance test (OGTT). All women found to have GDM underwent self-monitoring of blood glucose measurements as well as dietary management. Insulin treatment was initiated when dietary treatment did not achieve the glycemic goal. Of the 995 women, 141 had GDM (14.2%): 104 with one, 27 with two, and 10 with three abnormal OGTT values. Women with two or three abnormal OGTT values (2/3-AV) needed insulin treatment more frequently than those with one abnormal OGTT value (1-AV) (70.3% vs 23.1%, P < 0.0001). After adjustment for age, pregravid overweight, gestational weeks at diagnosis, a first-degree family history of diabetes was correlated with the implementation of insulin treatment in women with 1-AV (adjusted odds ratio 3.9; 95% Confidence Interval 1.7-9.2; P = 0.001). When compared perinatal outcomes between women with normal glucose tolerance and GDM, fetal growth and the occurrence of pregnancy-induced hypertension were comparable between the two groups. Our data suggest that the IADPSG-defined GDM with 1-AV show less severe glucose intolerance, but might be at risk of insulin requirement when a first-degree family history of diabetes exists.