15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2025

Diabetes Care, Journal Year: 2024, Volume and Issue: 48(Supplement_1), P. S306 - S320

Published: Dec. 9, 2024

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide components diabetes care, general treatment goals guidelines, tools evaluate quality care. Members ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating Standards annually, or more frequently as warranted. For a detailed description standards, statements, reports, well evidence-grading system full list Committee members, please refer Introduction Methodology. Readers who wish comment on invited do so at professional.diabetes.org/SOC.

Language: Английский

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Oral Glucose-Lowering Agents vs Insulin for Gestational Diabetes

JAMA, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 6, 2025

Importance Metformin and glyburide monotherapy are used as alternatives to insulin in managing gestational diabetes. Whether a sequential strategy of these oral agents results noninferior perinatal outcomes compared with alone is unknown. Objective To test whether treatment glucose-lowering for prevention large-for-gestational-age infants. Design, Setting, Participants Randomized, open-label noninferiority trial conducted at 25 Dutch centers from June 2016 November 2022 follow-up completed May 2023. The study enrolled 820 individuals diabetes singleton pregnancies between 16 34 weeks gestation who had insufficient glycemic control after 2 dietary changes (defined fasting glucose >95 mg/dL [>5.3 mmol/L], 1-hour postprandial >140 [>7.8 or 2-hour >120 [>6.7 measured by capillary self-testing). Interventions were randomly assigned receive metformin (initiated dose 500 mg once daily increased every 3 days 1000 twice highest level tolerated; n = 409) (prescribed according local practice; 411). Glyburide was added metformin, then substituted glyburide, if needed, achieve targets. Main Outcomes Measures primary outcome the between-group difference percentage infants born large age (birth weight >90th percentile based on sex). Secondary included maternal hypoglycemia, cesarean delivery, pregnancy-induced hypertension, preeclampsia, gain, preterm birth injury, neonatal hyperbilirubinemia, intensive care unit admission. Results Among participants, mean 33.2 (SD, 4.7) years). In participants randomized agents, 79% (n 320) maintained without insulin. With 23.9% 97) vs 19.9% 79) (absolute risk difference, 4.0%; 95% CI, −1.7% 9.8%; P .09 noninferiority), confidence interval exceeding absolute margin 8%. Maternal hypoglycemia reported 20.9% 10.9% 10.0%; 3.7%-21.2%). All other secondary did not differ groups. Conclusions Relevance Treatment additional meet criteria respect proportion age. Trial Registration Netherlands Registry Identifier: NTR6134

Language: Английский

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Glucagon-like peptide-1 receptor agonist use in pregnancy: a review

American Journal of Obstetrics and Gynecology, Journal Year: 2024, Volume and Issue: 232(1), P. 17 - 25

Published: Aug. 23, 2024

Language: Английский

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Favorable Antiviral Effect of Metformin on Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load in a Randomized, Placebo-Controlled Clinical Trial of Coronavirus Disease 2019

Clinical Infectious Diseases, Journal Year: 2024, Volume and Issue: 79(2), P. 354 - 363

Published: May 1, 2024

Abstract Background Metformin has antiviral activity against RNA viruses including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The mechanism appears to be suppression of protein translation via targeting the host mechanistic target rapamycin pathway. In COVID-OUT randomized trial for outpatient disease 2019 (COVID-19), metformin reduced odds hospitalizations/death through 28 days by 58%, emergency department visits/hospitalizations/death 14 42%, and long COVID 10 months 42%. Methods was a × 3 randomized, placebo-controlled, double-blind that assessed metformin, fluvoxamine, ivermectin; 999 participants self-collected anterior nasal swabs on day 1 (n = 945), 5 871), 775). Viral load quantified using reverse-transcription quantitative polymerase chain reaction. Results mean SARS-CoV-2 viral 3.6-fold with relative placebo (−0.56 log10 copies/mL; 95% confidence interval [CI], −1.05 −.06; P .027). Those who received were less likely have detectable than at or (odds ratio [OR], 0.72; CI, .55 .94). rebound, defined as higher 5, frequent (3.28%) (5.95%; OR, 0.68; .36 1.29). effect consistent across subgroups increased over time. Neither ivermectin nor fluvoxamine showed placebo. Conclusions this placebo-controlled treatment SARS-CoV-2, significantly load, which may explain clinical benefits in trial. is pleiotropic other actions are relevant COVID-19 pathophysiology. Clinical Trials Registration NCT04510194.

Language: Английский

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Metformin in pregnancy and childhood neurodevelopmental outcomes: a systematic review and meta-analysis

American Journal of Obstetrics and Gynecology, Journal Year: 2024, Volume and Issue: 231(3), P. 308 - 314.e6

Published: March 7, 2024

Language: Английский

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Can short‐ and long‐term maternal and infant risks linked to hypertension and diabetes during pregnancy be reduced by therapy?

Journal of Internal Medicine, Journal Year: 2024, Volume and Issue: 296(3), P. 216 - 233

Published: July 24, 2024

Hypertensive disorders of pregnancy (HDP), especially preeclampsia, and diabetes during pose significant risks for both maternal infant health, extending to long-term outcomes such as early-onset cardiovascular disease metabolic disorders. Current strategies managing HDP focus on screening, prevention, surveillance, timely intervention. No disease-modifying therapies exist so far established preeclampsia; delivery remains the definitive resolution. Preventive measures-including early exercise, low-dose aspirin-show promise. Antihypertensive treatments reduce severe hypertension risks, whereas magnesium sulfate standard preventing eclampsia. Planned from gestational week 37 can balance benefits neonatal in women with preeclampsia. Delivery between 34 weeks gestation preeclampsia has mother infant. Lifestyle interventions-particularly diet physical activity-are pivotal mellitus type 2 diabetes. The oral antidiabetic metformin shown glycaemic control reducing weight gain, although its effects offspring remain uncertain. safety other peroral antidiabetics is less studied. Advancements glucose monitoring insulin administration present encouraging prospects enhancing types 1 2. Both necessitate vigilant management through a combination lifestyle modifications, pharmacological interventions, obstetric care. Although certain aspirin show efficacy risk reduction, further research ongoing ensure mothers their short- adverse effects.

Language: Английский

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Diagnosis and Treatment of Hyperglycemia in Pregnancy

Endocrinology and Metabolism Clinics of North America, Journal Year: 2024, Volume and Issue: 53(3), P. 335 - 347

Published: July 29, 2024

Language: Английский

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Continuous Glucose Monitoring for Management of Type 2 Diabetes and Perinatal Outcomes

Obstetrics and Gynecology, Journal Year: 2024, Volume and Issue: 144(5), P. 677 - 683

Published: May 23, 2024

To evaluate the association between continuous glucose monitoring in pregnant people with type 2 diabetes and perinatal outcomes.

Language: Английский

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For Gestational Diabetes Pharmacotherapy, Insulin Reigns Supreme

JAMA, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 6, 2025

Language: Английский

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Breastfeeding patterns among parturients with diabetes: A secondary analysis of the MOMPOD randomized clinical trial

Published: Jan. 1, 2025

Abstract Introduction Insulin resistance is associated with decreased milk supply in lactating people. Metformin hypothesized to increase breast production by decreasing insulin resistance, suggesting use may breastfeeding success. We aimed determine the association between metformin during pregnancy and initiation continuation. Methods This was a secondary analysis of MOMPOD randomized controlled trial versus placebo addition therapy among pregnant people type 2 diabetes early diabetes. included parturients who delivered living neonate, received at least one dose study drug or placebo, endorsed an intention breastfeed, completed survey. Breastfeeding intentions outcomes were collected utilizing questionnaire 24–30 weeks 30 days postpartum, respectively. The primary outcome postpartum defined exclusive partial breastfeeding. Secondary immediate as any hospital admission until day 3, onset lactogenesis (days), bra size, challenges. Baseline characteristics compared using chi‐square, t ‐test, Wilcoxon tests, appropriate. Results Among 794 women receiving either trial, 378 (47.6%) met inclusion criteria 194 (51.3%) 184 (48.7%) groups. There no significant differences baseline characteristics. Immediate comparable groups (91.1% vs. 88.9%, p = 0.53) there difference lactogenesis. rates lower all (76.0% 66.7%, 0.11). Also, breastfeeding, cup Conclusion Our data suggest patterns those pregnancy. Antepartum should not be recommended solely improve

Language: Английский

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