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Diabetes Mellitus: Type 2 and Gestational01:22

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Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia. The four categories of diabetes are type 1 diabetes, type 2 diabetes, other specific types of diabetes, and gestational diabetes.
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Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
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For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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Improving IV Insulin Administration in a Community Hospital
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Controversies in Gestational Diabetes.

Chloe A Zera1,2, Ellen W Seely2,3

  • 1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.

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PubMed
Summary

Screening and treatment for gestational diabetes mellitus (GDM) involve ongoing debates. This review discusses controversies in GDM diagnosis, management, and postpartum testing to aid clinical decision-making.

Keywords:
Gestational diabetes mellitusglyburideinsulinmetforminscreeningtreatment

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Area of Science:

  • Obstetrics and Gynecology
  • Endocrinology
  • Maternal-Fetal Medicine

Background:

  • Gestational diabetes mellitus (GDM) affects approximately 7% of pregnancies in the USA.
  • Despite recognized benefits, significant controversies persist regarding GDM diagnosis and management.
  • Effective postpartum screening for type 2 diabetes in women with GDM remains a challenge.

Purpose of the Study:

  • To review and discuss current controversies in gestational diabetes mellitus diagnosis and management.
  • To present data supporting different sides of diagnostic and therapeutic debates.
  • To inform clinicians in making patient-centered decisions regarding GDM care.

Main Methods:

  • Review of existing literature and data on GDM screening strategies (one-step vs. two-step).
  • Analysis of evidence regarding optimal treatment modalities, including insulin regimens and oral agents.
  • Discussion of challenges and alternative approaches for postpartum type 2 diabetes screening.

Main Results:

  • The one-step screening approach identifies more pregnancies with potential adverse outcomes but lacks definitive outcome data for treatment.
  • While GDM treatment improves outcomes, optimal insulin types/regimens and the safety/efficacy of oral agents are debated.
  • A significant number of women with GDM do not adhere to recommended postpartum type 2 diabetes testing.

Conclusions:

  • Clinical decisions regarding GDM screening and management should be patient-centered, considering available evidence.
  • Further research is needed to resolve controversies surrounding GDM diagnostic criteria and treatment efficacy.
  • Innovative strategies are required to improve postpartum type 2 diabetes screening rates in women with a history of GDM.