Using Meal-Based Self-Monitoring of Blood Glucose as a Tool to Improve Outcomes in Pregnancy Complicated By Diabetes |
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| Institution: | 1. Department of Biomedical Engineering, Division of Endocrinology, Faculty of Medicine, McGill University, Montréal, QC H3A 2B4, Canada;2. Division of Experimental Medicine, Department of Medicine, McGill University, Montréal, QC H3A 2B4, Canada;3. Institut de Recherches Cliniques de Montréal, Montréal, QC, Canada;4. Montreal Children''s Hospital, McGill University Health Centre, Montréal, QC, Canada;5. Nutrition Department, Faculty of Medicine, University of Montréal, Montréal, QC, Canada;6. Montreal Diabetes Research Center, Montreal, QC, Canada;1. Departments of Pathology and Pediatrics, University of Florida, Gainesville, FL 32610-0275, USA;2. International Diabetes Federation Life for a Child Program, and Australian Diabetes Council, Sydney, NSW, Australia;1. Anderson Orthopaedic Clinic, Arlington, VA, USA;2. Georgetown University Hospital, Washington, DC, USA;3. Rothman Institute, Philadelphia, PA, USA;4. Eastern Virginia Medical School, Norfolk, VA, USA;5. Clinical Practices of the University of Pennsylvania, Philadelphia, PA, USA;6. Panorama Orthopedics, Golden, CO, USA;1. Department of Clinical Laboratory, Children''s Hospital of Shanghai, Shanghai Jiaotong University, Shanghai, China;2. Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China;1. Director of the Center for Infrastructure, Transportation, and the Environment, Department of Civil and Environmental Engineering, Rensselaer Polytechnic Institute, 110 8th St., Troy, NY 12180, USA;2. Department of Supply Chain and Information Systems, Iowa State University, 2340 Gerdin Business Building, Ames, IA 50011, USA;3. Department of Civil and Environmental Engineering, Fundación Universidad del Norte, Km 5 Vía a Puerto Colombia, Barranquilla, Colombia;4. Academic Director Humanitarian Research Group, INSEAD, Fontainebleau, France;5. Department of Industrial and Systems Engineering, Ohio University, 1 Ohio University, Athens OH 45701, USA;6. Department of Civil and Environmental Engineering, University of California, One Shields Avenue, Davis, CA 95616, USA;1. Department of Electrical and Computer Engineering, National University of Singapore, Singapore;2. Institute for Infocomm Research, A*STAR, Singapore |
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| Abstract: | ObjectiveTo review the importance of controlling blood glucose levels and the role of self-monitoring of blood glucose (SMBG) in the management of pregnancy complicated by diabetes.MethodsThis report describes the relationship between hyperglycemia and maternal and neonatal complications, reviews the utility of meal-based SMBG in modifying food choices and adjusting insulin doses, and proposes an algorithm to achieve normoglycemia in pregnancies complicated by diabetes.ResultsThe risk of diabetes-related complications in pregnancy is more strongly associated with 1-hour post-prandial plasma glucose concentrations than with fasting plasma glucose levels. SMBG strategies that incorporate postprandial glucose testing provide better glycemic control and greater reductions in risk of complications than does preprandial glucose testing alone. Although the optimal timing and frequency of SMBG remain controversial, available clinical evidence supports testing 4 times per day (before breakfast and 1 hour after each meal) in women with gestational diabetes managed by medical nutrition therapy only and 6 times per day (before and 1 hour after each meal) in pregnant women treated with insulin.ConclusionMeal-based SMBG is a valuable tool for improving outcomes in pregnancy complicated by diabetes. The lessons learned in this setting should have relevance to the general population of patients with diabetes, in whom microvascular and macrovascular complications are the outcomes of importance. (Endocr Pract. 2008; 14:239-247) |
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