How can we optimize gestational diabetes management effectively and safely? Let's start..
🩺🤰 As a pharmacist, focus on lifestyle for gestational diabetes (GD). Rates ↑, likely due to obesity, worsened by pandemic. Risks incl. C-section, fetal macrosomia, future DM, etc.
🥗💪 Emphasize "lifestyle Rx": healthy diet + exercise. If insufficient, discuss meds. Similar approach for GD or preexisting DM in pregnancy. Insulin first-line: longest track record, easier to fine-tune as pregnancy progresses. Oral meds not always enough.
- If not, consider metformin (Glucophage): less weight gain than insulin, but less safety data.
- Reserve glyburide (Daonil) as last resort: linked to worse outcomes (macrosomia, etc) than metformin/insulin.
- Avoid other sulfonylureas & diabetes meds due to lack of long-term data.
- 📊 🩸Check BG 4x/day with standard meter; evidence limited with CGMs in GD.
- Aim for fasting < 95 mg/dL, < 140 mg/dL 1hr post-meal OR < 120 mg/dL 2hr post-meal. If well-managed with lifestyle alone, reduce to 2x/day checks.
- Post-delivery, follow-up for prediabetes, type 2 DM, CV risks, etc.
References
- Gregory EC, Ely DM. Trends and Characteristics in Gestational Diabetes: United States, 2016-2020. Natl Vital Stat Rep. 2022;71(3):1-15.
- ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018;131(2):e49-e64.
