Effect of 3-day intensive dietary therapy during admission in women after diagnosis of gestational diabetes mellitus.

Sunsaneevithayakul, Prasert; Ruangvutilert, Pornpimol; Sutanthavibul, Anuwat; Kanokpongsakdi, Sujin; Boriboohirunsarn, Dittakarn; Raengpetch, Yoopin; Lertpadungkulchai, Supannee

Effect of 3-day intensive dietary therapy during admission in women after diagnosis of gestational diabetes mellitus.

Date

2004-09-02

Authors

Sunsaneevithayakul, Prasert

Ruangvutilert, Pornpimol

Sutanthavibul, Anuwat

Kanokpongsakdi, Sujin

Boriboohirunsarn, Dittakarn

Raengpetch, Yoopin

Lertpadungkulchai, Supannee

Abstract

OBJECTIVE: To determine the impact of 3-day intensive dietary therapy during admission on glycemic control. MATERIAL AND METHOD: GDM women, with level of fasting blood glucose (FBS) at or above 105 mg/dl on their oral glucose tolerance test (OGTT), were hospitalized. After 3-day intensive dietary therapy, the women were stratified by FBS value and mean 2-hour postprandial blood glucose. Those with poor glycemic control, FBS at or above 105 mg/dl, were prescribed insulin therapy. RESULT: Between 1 August 2001 to 31 December 2002, a total of 9861 pregnant women were screened for clinical risk factors of GDM at their first antenatal visits, and 4663 had at least 1 risk. After 50-gm glucose challenge test and 100-gm OGTT GDM was diagnosed in 300 women. Only 18% (54 in 300 cases) of GDM had level of FBS at or above 105 mg/dl on OGTT. They were admitted in a special ward for further investigation and initial management. After 3 days of intensive dietary therapy, the FBS and mean 2-hour postprandial blood glucose level were monitored and stratified in 3 groups. Only 42.6% of admission group (23 in 54 cases) still had FBS at or above 105 mg/dl and required insulin therapy (group 1). One third (18 in 54 cases) could avoid insulin therapy due to the level of FBS below 105 mg/dl and mean 2-hour postprandial blood glucose below 120 mg/dl (group 2). This second group was discharged, and due to attend the high risk pregnancy clinic a few weeks later The third group (group 3), comprising one fourth (13 in 54 cases), had FBS below 105 mg/dl but had a mean 2-hour postprandial blood glucose at or above 120 mg/dl. This third group were also discharged and were monitored glycemic profile by FBS and 2-hour postprandial blood glucose every time during their visits to the high risk pregnancy clinic. According to criteria of 2-hour postprandial blood glucose at or above 120 mg/dl on two or more occasions within a 1-2 weeks interval, no one in group 3 needed insulin therapy afterward CONCLUSION: GDM women with FBS at or above 105 mg/dl on their OGTT, should be prescribed intensive dietary therapy alone for 3 days inside hospital rather than initiating insulin immediately after diagnosis. One third had a benefit of avoiding insulin therapy. Only 42% failed to achieve good glycemic control and still needed insulin therapy. One fourth showed optimal glycemic control after this intervention (FBS below 105 mg/dl) but had mean 2-hour postprandial blood glucose at or above 120 mg/dl. Longer trial of dietary therapy should be considered in this last group to avoid over treatment of insulin therapy.

Description

Chotmaihet Thangphaet.

Citation

Sunsaneevithayakul P, Ruangvutilert P, Sutanthavibul A, Kanokpongsakdi S, Boriboohirunsarn D, Raengpetch Y, Lertpadungkulchai S. Effect of 3-day intensive dietary therapy during admission in women after diagnosis of gestational diabetes mellitus. Journal of the Medical Association of Thailand. 2004 Sep; 87(9): 1022-8