Comprehensive Care for Gestational Diabetes Women with diabetes need comprehensive care before and d

Comprehensive Care for Gestational Diabetes Women with diabetes need comprehensive care before and during pregnancy. The Diabetes and Pregnancy Program (DAPP) at UC San Diego Health, the only one of its kind in the San Diego Region, cares for the diverse population of women with diabetes in San Diego County. DAPP is designed to provide specialized care to patients with diabetes through a multidisciplinary approach, following the California Diabetes and Pregnancy Program guidelines. “Patients with type 1 or type 2 diabetes, or those who have recently been diagnosed with gestational diabetes, require a team of specialists to assist with a healthy pregnancy and optimize the outcome for both the patient and baby,” said Sandy Ramos, MD, director of DAPP and perinatologist at UC San Diego Health. “For example, working with a specialist to manage blood sugar before and during pregnancy can decrease the risk of complications and make it more likely that the patient can carry the baby to term.”Ramos and Kristen Kulasa, MD, endocrinologist at UC San Diego Health, elaborate:Question: How common is gestational diabetes and what are the complications?Answer: Approximately one in five women delivering babies in San Diego County begin their pregnancies with diabetes, and others develop gestational diabetes during pregnancy. These women are at risk for complications during pregnancy and after delivery, including high blood pressure, eye disease, kidney disease, too much weight gain, severe hypoglycemia (low blood sugar) and diabetic ketoacidosis (DKA). Their babies are also at increased risk for complications, including macrosomia (high birth weight), higher rates of miscarriage and stillbirth, birth defects, delivery complications and jaundice.Q: What type of services does DAPP provide?A: DAPP includes six certified diabetes care and education specialists (DECS), nutritionists and social workers under the direction of two maternal fetal medicine experts. The program provides care to approximately 500 patients with gestational diabetes, 120 patients with type 2 diabetes and 40 patients with type 1 diabetes per year. As a clinical program in the region’s only academic medical center, DAPP provides leading edge diabetes care from preconception to postpartum, utilizing the latest technology available, including the use of sophisticated insulin pumps and continuous glucose monitoring.  For example, the DAPP team has found success using “closed loop systems” to improve glucose control in patients with type 1 diabetes in pregnancy. This technology allows integration of information from the continuous glucose monitor to augment or “talk” to insulin pumps. This allows the insulin pump to increase insulin delivery if the glucose values are high or to decrease or even suspend insulin delivery if the glucose value is low. With the aim of improving the maternal and neonatal outcomes of women with diabetes, patients are also given the opportunity to participate in clinical trials, such as the Medical Optimization of Management of Pregnancy with Overt Diabetes (MOMPOD) trial, a randomized clinical trial of Metformin as an adjunct to insulin for the treatment of type 2 diabetes. DAPP provides primary obstetrical care for complicated patients with diabetes and is able to provide consultative services to co-manage patients with gestational diabetes.  Q: How are you addressing gestational diabetes with patients in terms of lifestyle interventions and medications available? A: To treat gestational diabetes, we encourage nutrition changes to limit simple carbohydrates and recommend exercise. Most patients with gestational diabetes can manage their glucose values with these changes alone. If elevations persist, they can be treated with medicines like insulin and metformin. However, these lifestyle changes are important tools to continue to lower the risk of development of type 2 diabetes. Women who develop gestational diabetes have a higher risk of developing type 2 diabetes later in life.Q: What research needs to be done to improve how diabetes is managed in pregnancy? A:  There are many new medications used for management of type 2 diabetes that haven’t been studied in pregnancy. The issue of safety of these medications needs further exploration in pregnancy. Additionally, technology, including blue tooth-enabled meters and continuous glucose monitors, commonly used in type 1 diabetes, need to be studied in other types of diabetes in pregnancy to see if they may be useful tools to improve the care of women with diabetes.— Michelle Brubaker -- source link

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