M. G. Dalfrà

New International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations for diagnosing gestational diabetes compared with former criteria: a retrospective study on pregnancy outcome.

Diabet. Med. 28, 1074–1077 (2011)

Use of insulin detemir in pregnancy: a report on 10 Type 1 diabetic women

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Insulin therapy in pregnancy complicated by diabetes: are insulin analogs a new tool?

It has been demonstrated that good metabolic control maintained throughout pregnancy can reduce maternal and fetal complications in diabetes. To achieve good metabolic control, before conception and throughout pregnancy, insulin therapy needs to be optimized, and, in this context, the new insulins currently on the market may help. We therefore review here what is known about the potential benefits and risks related to the use of these new insulins in pregnancy. Clinical and experimental data on insulin lispro strongly suggest that lispro does not have adverse maternal or fetal effects during pregnancy in women with preexisting diabetes, and also that its use in these women results in improved glycemic control, fewer hypoglycemic episodes, and improved patient satisfaction. In women with gestational diabetes mellitus (GDM), the use of insulin lispro is efficient in reducing postprandial hyperglycemia and some neonatal features related to hyperglycemia, thus stressing its usefulness in this condition. As for insulin aspart, clinical data on GDM patients shows the same efficacy as insulin lispro in lowering postprandial hyperglycemia, indicating that insulin aspart may be used in GDM when this condition is characterized by postprandial hyperglycemia. The results of a multicentric study now in progress on the efficacy and safety of insulin aspart in type 1 pregnant diabetic patients will definitely be useful in establishing whether this insulin is safe in pregnancy. For the moment, the use of insulin glargine during pregnancy is not recommended owing to the lack of data on maternal and fetal effects. Copyright

Glucose Fluctuations during Gestation: An Additional Tool for Monitoring Pregnancy Complicated by Diabetes

Continuous glucose monitoring (CGM) gives a unique insight into magnitude and duration of daily glucose fluctuations. Limited data are available on glucose variability (GV) in pregnancy. We aimed to assess GV in healthy pregnant women and cases of type 1 diabetes mellitus or gestational diabetes (GDM) and its possible association with HbA1c. CGM was performed in 50 pregnant women (20 type 1, 20 GDM, and 10 healthy controls) in all three trimesters of pregnancy. We calculated mean amplitude of glycemic excursions (MAGE), standard deviation (SD), interquartile range (IQR), and continuous overlapping net glycemic action (CONGA), as parameters of GV. The high blood glycemic index (HBGI) and low blood glycemic index (LBGI) were also measured as indicators of hyperhypoglycemic risk. Women with type 1 diabetes showed higher GV, with a 2-fold higher risk of hyperglycemic spikes during the day, than healthy pregnant women or GDM ones. GDM women had only slightly higher GV parameters than healthy controls. HbA1c did not correlate with GV indicators in type 1 diabetes or GDM pregnancies. We provided new evidence of the importance of certain GV indicators in pregnant women with GDM or type 1 diabetes and recommended the use of CGM specifically in these populations.

Gestational Diabetes Mellitus and Future Cardiovascular Risk: An Update

The prevalence of gestational diabetes mellitus is increasing in parallel with the rising prevalence of type 2 diabetes and obesity around the world. Current evidence strongly suggests that women who have had gestational diabetes mellitus are at greater risk of cardiovascular disease later in life. Given the growing prevalence of gestational diabetes mellitus, it is important to identify appropriate reliable markers of cardiovascular disease and specific treatment strategies capable of containing obesity, diabetes, and metabolic syndrome in order to reduce the burden of cardiovascular disease in the women affected.

Team management of gestational diabetes: a training experience

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance developing or first recognized during pregnancy that is not clearly overt diabetes [1]. It affects from 5–6 up to 15–20% of pregnancies worldwide, depending on population demographics, screening methods, diagnostic criteria in use, and maternal lifestyle [2]. GDM is characterized by a defective insulin secretion and insulin resistance even in early pregnancy [3, 4]. Left untreated, GDM can complicate pregnancy, affecting neonatal growth and maternal health, and causing macrosomia, fetal congenital anomalies, intrauterine fetal death, neonatal hypoglycemia, neonatal hyperbilirubinemia, birth trauma, preeclampsia, premature delivery [1]. GDM is also associated with long-term consequences for the women. They have an increased risk of type 2 future diabetes, in particular in the presence of obesity, insulin treatment during pregnancy, and a family history of diabetes [5]. They also have a greater than threefold risk of metabolic syndrome compared to women with normal glucose tolerance in pregnancy [6]. A multidisciplinary team operating in a secondary or tertiary care setting is a commonly adopted model for the provision of pregnancy care to women with diabetes. In fact, in the literature, there are evidences that demonstrated that a systematic multidisciplinary management of pregnant women in the diagnosis and treatment of GDM is essential to contain these maternal and fetal complications [7]. The universal implementation of this best practice could transform the outcomes for women with GDM. But, on the basis of clinical experience, the organization of outpatient clinic and the composition of the multidisciplinary team vary according to local circumstances. These circumstances can lead to some problems in management of GDM patient decreasing the quality of patients’ management. The Italian DAWN Study Group on Pregnancy performed a survey to evaluate the wishes and the needs of Italian and immigrant women affected by GDM. The results showed that all women received structured care from a multidisciplinary team comprising diabetologists, experienced nurses, and dietitians. On the other hand, gynecologists and diabetes specialists cooperated in only 25–26% of cases, and 73% of pregnant women felt that a better cooperation between practitioners is the best way to improve the care available to pregnant women with GDM [8]. To overcome the weaknesses of multidisciplinary teams operating at different diabetic outpatient clinics in different Italian regions, enabling them to facilitate task sharing and standardize their GDM patient management, we conducted a training experience. Our clinic adopt a multidisciplinary team approach meeting the standards recommended in national and international guidelines, so our team experienced in GDM management, including a diabetologist, a nurse, a dietitian, and a gynecologist, was the trainer team of the experience. A total of 13 multidisciplinary teams comprising a diabetologist, a nurse, a dietitian, and a gynecologist operating at different diabetic outpatient clinics of 5 Italian regions (Veneto, Lombardia, Emilia Romagna, Trentino Alto Managed by Antonio Secchi.