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Abstract

GESTATIONAL DIABETES MELLITUS (GDM) - OVERVIEW OF DIAGNOSIS, MEDICAL NUTRITION THERAPY AND PHARMACOTHERAPY MANAGEMENT

Dr. Nalini Kumari*, Dr. V. M. Motghare and Dr. Kalpana Dash

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Abstract

The prevalence of gestational diabetes mellitus (GDM) is 25.9% as per International Diabetes Federation 2021. Any degree of glucose intolerance with onset or first recognition during pregnancy is known as GDM. The prevalence of GDM is also increasing dramatically in the reproductive age group, as the prevalence of type 1 diabetes and type 2 diabetes is increasing in women. Diabetes has a significant risk factor on maternal and fetal health, and the degree of hyperglycemia is also related to chronic complications and comorbidities of diabetes. Women with GDM are at increased risk, and it may lead to preeclampsia and cardiovascular complication. If fasting plasma glucose level >126 mg/dl (7.0 mmol/l) or random plasma glucose 200 mg/dl (11.1 mmol/l) meets the threshold for the diagnosis of diabetes, then need to go for an oral glucose challenge test. Nutritional requirements of women with GDM are similar to non-GDM pregnancies, but it requires special dietary modification to achieve and maintain maternal euglycemia levels. Despite recommended diet and lifestyle modification, managing the adequate glycemic level is difficult. Insulin and oral medications are both used to control hyperglycemia in GDM patients. The dose and timing of insulin administration may vary depending on when hyperglycemia occurs. Currently, available insulin analogs include rapidly acting analogs, such as Aspart (Novolog) and Lispro (Humalog), short-acting regular insulin, intermediate-acting NPH insulin, or longer-acting insulin analogs such as Glargine (Lantus) and Detemir (Levemir).

Keywords: Gestational diabetes mellitus, medical nutrition therapy, insulin, insulin analogs, metformin.


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