Management of gestational diabetes

Researchers and care providers must recognize that different centers are not automatically comparable in results because the geographic location, the demographic characteristics of the patient population, and the program strategy will alter the rate of patients assigned to insulin therapy and adverse pregnancy outcome. For example, in San Antonio, Texas, with a chronic health problem of obesity and diabetes, the prevalence of GDM is approximately 11%, whereas the general reported rate is 2% to 3%. Despite the disparity in the prevalence of the disease in different demographic areas, pregnancy outcome should be comparable for all centers when a proper management approach has been used. Utilizing our management approach in a large-scale program resulted in an incidence of macrosomia comparable to that in the general population. As a general rule, because constant evaluation of glycemia in pregnancy is the best gauge of the efficacy of the treatment, the use of verified self-monitoring of blood glucose has become a principal component of management. Appropriate assignment of patients to treatment modality utilizing verified blood glucose determinations and targeting mean blood glucose levels throughout pregnancy to 95 mg/dL (5.3 mmol/L) that is similar to normal nondiabetic blood glucose levels will result in pregnancy outcome comparable to the general population.