Controversies in Gestational Diabetes.

TouchREVIEWS in endocrinology Pub Date : 2021-11-01 Epub Date: 2021-08-04 DOI:10.17925/EE.2021.17.2.102
Chloe A Zera, Ellen W Seely
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Abstract

Gestational diabetes mellitus (GDM) complicates approximately 7% of pregnancies in the USA. Despite recognition of the benefits of diagnosing and treating GDM, there are several areas of controversy that remain unresolved. There is debate as to whether to screen for GDM with the one-step versus the two-step approach. While the former identifies more pregnancies with potential adverse outcomes, data are lacking as to whether treatment of these pregnancies will improve outcomes, while increasing costs by diagnosing more women. Though it is well established that the diagnosis of even mild GDM, and treatment with lifestyle recommendations and insulin, improves pregnancy outcomes, it is controversial as to which type and regimen of insulin is optimal, and whether oral agents can be used safely and effectively to control glucose levels. Finally, it is recommended that women with GDM get tested for type 2 diabetes within several months of delivery; however, many women do not undergo this testing and alternative approaches are needed. These controversies are discussed with data from both sides of the debate to enable clinicians to make patient-centered decisions until more definitive data are available.

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妊娠期糖尿病的争议。
在美国,妊娠期糖尿病(GDM)并发症约占妊娠的7%。尽管认识到诊断和治疗GDM的好处,但仍有几个争议领域尚未解决。关于是用一步法还是两步法筛查GDM存在争议。虽然前者确定了更多有潜在不良后果的怀孕,但缺乏数据表明,对这些怀孕的治疗是否会改善结果,同时因诊断出更多的妇女而增加了成本。虽然已经确定,即使是轻度GDM的诊断,以及生活方式建议和胰岛素治疗,都可以改善妊娠结局,但哪种类型和方案的胰岛素是最佳的,以及口服药物是否可以安全有效地控制血糖水平,这些都是有争议的。最后,建议患有GDM的妇女在分娩后几个月内进行2型糖尿病检测;然而,许多妇女不接受这种检查,需要其他方法。这些争议讨论与数据从辩论双方,使临床医生做出以患者为中心的决定,直到更明确的数据可用。
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