The comparison of the effectiveness of treatment options in gestastional diabetes: Diet vs. insulin treatment

Şişik, N. (2016). The Comparison Of The Effectıveness Of Treatment Options In Gestastıonal Diabetes: Diet Vs. Insulin Treatment. Yeditepe University, Institute of Health Sciences, Department of Nutrition and Dietetics, MSc thesis. İstanbul. Gestational diabetes mellitus (GDM) is a severe condition which progresses with maternal obstetric and fetal complications if a well glycemic control cannot be provided. The basic principal of the therapy is medical nutrition therapy (MNT) and exercise. In cases where the foregoing is inadequate, glycemic control is provided with insulin therapy. The aim of this study is to compare those who are monitored with MNT with those who receive insulin in women who are diagnosed with GDM in terms of complication growth.147 pregnant women who were diagnosed with GDM during the pregnancy for the first time but had no previously known diabetes and glucose intolerance were recruited into this study. In all pregnant women, 24kcal/kg standard diet was applied in obese diabetes, 30kcal/kg in non-obese diabetes in the 1st trimester and 35kcal/kg in the 2nd trimester as from the diagnosis establishment. In the presence of uncontrolled glycemia with two weeks of SMBG (capillary blood glucose profile), insulin was started. Fasting blood glucose targeted was determined as < 95 mg /dl and 1st hour postprandial blood glucose as <140mg/dl during the pregnancy. At least 2 days 7 points blood glucose measurement was requested from all pregnant women in a week. Data collected were compared at the end of pregnancy.105 of pregnant women (71,4%) were monitored by starting medical nutrition therapy (MNT group), 42 (28,6%) were monitored with insulin therapy in addition to medical nutrition therapy (MNT+insulin group). Age average of pregnant women in MNT group was found higher than the average age of pregnant women in MNT+insülin group. (32,4+/-3,8 vs. 34,1+/-3,9 p= 0,018). When BMI values were compared between groups, a difference was not observed. No difference was found between groups in terms of weight gained in the pregnancy and birth week. A difference was not observed between groups in terms of GDM risk factors (DM history in the family, BMI, GDM history, fat infant history). No difference was found between groups in terms of maternal (preeclampsia, birth complications) and fetal (infant weight, prematurity, APGAR score) complications. Glycemic control is essential in pregnant women who are followed due to GDM. Monitoring only with nutrition or starting insulin therapy does not increase the complication risk. Key words: Gestastional diabates mellitus, GDM, insulin, medical nutrition therapy