Gestasyonel Diyabet Tanı ve Tedavisi

ÖzGestasyonel diyabet (GDM), gebeliğe bağlı gelişen insülin direnci ve genetik yatkınlıkla ilişkilidir. GDM hem bebek hem de annede olumsuz sonuçlara yol açar. GDM olankadınlarda tip 2 DM, tip 1 DM ve kardiyovasküler hastalık riski de artmıştır. GDM erken tanı ve etkin tedavisi maternal ve fetal komplikasyonlar ile uzun dönem komplikasyonları azaltır. GDM risk faktörlerinden en az birine sahip olanlarda GDM riski artmıştır, risk faktörü sayısı arttıkça risk de artar. GDM için tarama iki veya tek aşamalı oralglikoz tolerans testi (OGTT) olarak yapılabilir. En iyi tarama testi hakkında hala fikir birliği bulunmamaktadır. Erken gebelikte taramanın faydasına ait kanıt bulunmamaklaberaber tanı konulmamış tip 2 DM şüphesi yüksek kadınlarda ilk prenatal vizitte tarama veya tanı testleri yapılabilir. Eğer erken tarama yapılmadıysa veya negatifse taramanın 24-28. gestasyonel haftalarda yapılması önerilmektedir. GDM’da tedavinin perinatal sonuçları iyileştirdiği çalışmalarla gösterilmiştir. Hedef diyabetik olmayan gebe kadınlarınkine benzer glukoz değerlerine ulaşmaktır. GDM’da tedavinin birinci basamağını oluşturan tıbbi beslenme tedavisi (TBT) ve egzersiz programı ile kontrolün sağlanamadığı vakalarda insülin tedavisine başlanmalı vehasta tarafından yapılacak kan glikoz takibi ile tedavi düzenlenmelidir. Gebelik sırasında fetusun da yakın takibi gerekmektedir. Doğum sonrası yeni doğan metabolik bozukluklar açısından yakından izlenmelidir. GDM tanısı almış kadınlarda, doğumdan sonra 6-12. haftalarda standart 75 gram glikozlu, 2 saatlik OGTT yapılmalı ve gebe olmayan kişilerdeki gibi yorumlanmalıdır. GDM öyküsü bulunan kadınlarda, yaşam boyu 1-3 yılda bir diyabet taraması yapılması gereklidir. GDM öyküsü bulunan kadınlarda kalıcı tip2 diyabet riski çok yüksektir. Bu kadınlarda ömür boyu sağlıklı yaşam tarzı girişimleriuygulanmalı ve gerekiyorsa metformin verilmelidir.

Anahtar Kelimeler:

Gestasyonel diyabet, riskfaktörleri, tarama, oral glikoz tolerans testi, tedaviyönetimi

Gestational Diabetes Mellutus: Diagnosis and Treatment

AbstractGestational diabetes (GDM) is associated with insulin resistance in pregnancy andgenetic predisposition. GDM may lead to various types of adverse outcomes for boththe foetus and the mother. Women with GDM are at increased risk of developing type2 diabetes, type 1 diabetes and cardiovascular disease. Identifying and treating GDM reduces maternal and foetal complications, as well as long term complications. Pregnant women with at least one risk factor appear to be at increased risk of developing GDM;the risk increases when multiple risk factors are present. Screening for GDM is performed using either a two step or one step oral glucose tolerance test. Currently there is noconsensus on the optimal approach to screen for GDM. While there are no proven benefits to screening for diabetes in early pregnancy,screening/testing can be performed as early as the first prenatal visit if there is a high degree of suspicion that the pregnant woman has undiagnosed type 2 diabetes. In the absence of early screening or if early screening/testing is negative, universal screening is performed at 24 to 28 weeks ofgestation. Treatment has been demonstrated to improve perinatal outcomes in two large randomized studies. The goal of therapy during pregnancy is to achieve glucose profiles similar to those of nondiabetic pregnant women. Treatmentof GDM starts with medical nutrition therapy. If normoglycemia cannot be maintained by medical nutritional therapyand exercise, then insulin therapy should be initiated and thetitration of insulin dose to blood glucose levels is based uponfrequent self-monitoring. Development of foetus during pregnancy and neonatal metabolic complications should be monitored closely. Women with GDM should be tested for per-sistent diabetes or prediabetes at 6–12 weeks’ postpartum with 75-gram OGTT using nonpregnancy criteria. Womenshould also be tested every 1–3 years thereafter. Women witha history of GDM have a greatly increased risk of conversion to type 2 diabetes over time. Lifelong intense lifestyle changes should be implemented and metformin shouldbe initiated if necessary.

Keywords:

Gestational diabetes, riskfactors, oral glucose tolerance test, management,

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