妊娠期糖尿病患者筛查、诊断标准及治疗管理的临床进展

Balaji Vijayam, T. Balaji, M. Balaji, Seshiah Veerasamy, Vinothapooshan Ganesan
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摘要

最普遍的代谢和内分泌围产期问题是妊娠期糖尿病(GDM),这是一个日益严重的全球健康问题。它是一个有争议的实体,有相互冲突的指导方针和治疗方案。在美国,大多数医生采用两步策略,首先在24至28周进行50克非禁食口服葡萄糖激发试验,然后对筛查结果呈阳性的女性进行100克禁食试验。或者,临床医生采用印度妊娠期糖尿病研究小组(DIPSI)的一步方法,简单地进行75克两小时的空腹口服葡萄糖耐量测试。产前GDM筛查的DIPSI方法已被证明是简单、经济、易于使用、对患者友好和方便的。当将这些发现与国际糖尿病和妊娠研究小组协会(IADPSG)的金标准进行比较时,DIPSI显示出高度特异性和可接受的敏感性。为了维持血糖正常,需要监测血糖、改变饮食、锻炼,必要时还需要药物。尽管胰岛素治疗是最常见的治疗方法,但格列本脲和二甲双胍可能会变得更受欢迎。从妊娠晚期开始的无压力测试和羊水指数的产前测试通常用于评估接受药物治疗的女性的胎儿健康状况。交付技术和时间存在争议。患有妊娠期糖尿病的女性在以后的生活中患2型糖尿病的风险很大。因此,除了常规糖尿病筛查外,还应建议调整生活方式。
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Clinical Updates on Screening and Diagnosis Criteria for Gestational Diabetes Mellitus Patients, as well as Therapeutic Management
The most prevalent metabolic and endocrine perinatal issue is gestational diabetes mellitus (GDM), which is an increasing health problem worldwide. It is a controversial entity, with conflicting guidelines and treatment protocols. In the United States, most doctors utilise a two-step strategy, first with a 50-g non fasting oral glucose challenge test at 24 to 28 weeks and then a 100-g fasting test for women who have a positive screening result. Alternatively, Clinicians take a one step Diabetes in Pregnancy Study Group India (DIPSI) method and perform simply a 75-g two hour fasting oral glucose tolerance test. The DIPSI approach of antenatal GDM screening has been demonstrated to be straightforward, cost effective, easy to use, patient friendly, and convenient. When comparing the findings to the gold standard of the International Association of Diabetes and Pregnancy Study Group (IADPSG), DIPSI shows high specificity and acceptable sensitivity. To maintain euglycemia, glucose monitoring, dietary changes, exercise, and, if necessary, medicines are used. Although insulin therapy is the most common treatment, glyburide and metformin may become more popular. Prenatal testing with nonstress tests and amniotic fluid indices, commencing in the third trimester, is commonly used to assess foetal well-being in women undergoing medication. The delivery technique and time are contentious. Women who have gestational diabetes are at a significant risk of developing type 2 diabetes later in life. As a result, along with routine diabetes screening, lifestyle adjustment should be recommended.
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