Early Blood Sugar Management is Essential for Gestational Diabetes

Gestational diabetes patients who experienced quick blood sugar improvement immediately after diagnosis had better delivery outcomes than those who experienced sluggish or no improvement. The study, which was released on September 29 in JAMA Network Open, found that patients who improved more slowly or did not achieve optimal glucose control were at an increased risk for caesarean delivery, large-for-gestational-age birth, shoulder dislocation during delivery or neonatal intensive care unit admission.

“Glycemic control is a cornerstone of gestational diabetes management, so it’s important to learn in detail about the trajectory of control between diagnosis and delivery,” said senior author Yeyi Zhu, PhD, a research scientist with the Kaiser Permanente Division of Research. “This study goes beyond identifying whether a patient has control of their blood sugar and offers insights into the role of timing of glycemic control.”

The study also shed light on the elements that helped patients manage their blood sugar levels early, including being in a gestational diabetes care programme, maintaining a healthy weight prior to pregnancy, abstaining from alcohol and tobacco during pregnancy and closely self-monitoring blood glucose levels, which patients were instructed to do four times per day.

All the participants in the study were part of the telemedicine programme for women with gestational diabetes run by the Kaiser Permanente Northern California Regional Perinatal Service Centre, or RPSC. The program provides standardized telephone advice on nutrition, exercise, glucose monitoring and blood-sugar-lowering drugs.

Does Personalized Care improve Glucose Control in Gestational Diabetes

“One thing that stood out to us about patients with early glucose control was that they were more likely to be engaged with the RPSC,” said lead author Rana Chehab, PhD, a research fellow with the Division of Research. “They were more likely to have phone calls with nurses and to do the glucose measurements at least 3 times a day.”

Prior to giving birth, the blood glucose levels of over 90% of the patients who took part in the telehealth support programme dramatically improved, according to the authors, which is significant.

Advertisement

“Managing one’s blood sugars in pregnancy can be difficult, and we give patients personalized care from very knowledgeable, caring staff members,” said study co-author Mara Greenberg, MD, a maternal-fetal medicine specialist with The Permanente Medical Group who directs the Regional Perinatal Service Centre. “This study shows great outcomes for the majority of our patients and we’re very proud of that.”

Glucose Control in Gestational Diabetes

In accordance with national guidelines, patients at high risk of developing gestational diabetes were screened earlier in pregnancy during the study period. Gestational diabetes is routinely screened for in pregnant Kaiser Permanente patients in Northern California near the end of the second trimester. Preeclampsia, early delivery, large-for-gestational-age babies, as well as long-term metabolic and cardiovascular issues, are just a few of the consequences that gestational diabetes can make more likely for both the mother and the unborn child.

Advertisement

Between January 2007 and December 2017, Kaiser Permanente in Northern California had 26,774 women enrolled in their gestational diabetes programme. The patients were found to be clustered into 4 different paths when the researchers reviewed the data on glucose control levels between diagnosis and delivery. 40% of people were ‘stably optimum’, meaning they had strong control to begin with and kept it. With a trajectory indicating a rapid improvement to optimal levels, 34% of the population was ‘rapidly improving to optimal’. When glucose management reached the goals suggested by the American Diabetes Association, it was deemed to be ‘optimal’.

26,774 people who had signed up for Kaiser Permanente’s gestational diabetes programme in Northern California between January 2007 and December 2017 were included in the study. The patients were grouped into 4 distinct trajectories, according to the analysis of the data on glucose control levels between diagnosis and delivery. Approximately 40% of people were ‘stably optimum’, starting with strong control and keeping it. A trajectory showed that 34% of the population was ‘rapidly improving to ideal’, with rapid improvement levels. When blood glucose levels reached the American Diabetes Association’s suggested levels, glucose control was deemed to be ‘optimal’.

“Previous studies categorized women as being in control of glucose or not, but we wanted to know if the timing of glucose control attainment mattered in terms of outcomes, and it does,” she said.

Future research could compare patients in various trajectories to learn how they differ. “Some patients are able to get glycemic control relatively quickly and stay there and other patients struggle, and we don’t always know why,” said Dr Greenberg.

Source-Medindia