Optimization of insulin therapy in patients with gestational diabetes.
OBJECTIVE
To discuss the new criteria for screening and diagnosis of gestational diabetes and present recommendations for patient management.


METHODS
Various strategies for detecting gestational diabetes historically and currently are reviewed, and approaches for optimizing patient and neonatal outcome are discussed.


RESULTS
Rather than testing for gestational diabetes selectively, universal screening of pregnant women between 24 and 28 weeks of gestation with use of a glucose challenge test and 1-hour assessment has been shown to decrease the rate of occurrence of neonatal macrosomia. Performance of both preprandial and postprandial self-monitoring of blood glucose levels helps to prevent pronounced postprandial glucose excursions and minimize the risk of neonatal macrosomia. In comparison with regular human insulin, insulin lispro has yielded significantly better metabolic control and a reduction in hypoglycemic episodes before breakfast in patients with gestational diabetes.


CONCLUSIONS
Women with gestational diabetes who are not optimally managed with diet and exercise need insulin therapy. Insulin lispro is associated with fewer hypoglycemic events and attenuates the postprandial response greater than does regular human insulin.
Jovanovic
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Sansum Medical Research Foundation, Santa Barbara, California 93105-3210, USA.
D016640:Diabetes, Gestational / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000031:analogs & derivatives / Q000627:therapeutic use*; D061268:Insulin Lispro; D008403:Mass Screening; D011247:Pregnancy
D007004:Hypoglycemic Agents; D007328:Insulin; D061268:Insulin Lispro