Treatment options for different subtypes of gestational diabetes

Background. Modern methods of treating gestational diabetes (GD) are aimed at preventing excessive fetal growth and the development of complications through lifestyle modification and diet therapy, and, if ineffective, insulin therapy. Taking into account the research data of recent years, different subtypes of GD based on the predominance of the pathological mechanism – β-cell defect, insulin resistance (IR) or a combination of these factors – are identified. Determining the subtype of GD can be of extreme clinical importance, since the choice of treatment tactics for patients and, as a result, their achievement of target blood glucose values may depend on the mechanisms underlying the pathogenesis of carbohydrate metabolism disorders.

Objective. Evaluation of the effectiveness of modern treatment methods depending on the GD subtype.

Methods. 130 pregnant women without a history of carbohydrate metabolism disorders were examined (an oral glucose tolerance test with 75 g of glucose and an additional determination of fasting insulin during the test). The subjects were divided based on the examination results, as well as calculation of the Matsuda index: group I – 45 pregnant women with GD and β-cell dysfunction, group II – 43 pregnant women with GD and IR. Additionally, all study participants were surveyed using a specially developed questionnaire. Statistical analysis was carried out using comparative analysis. Data are presented as medians and interquartile ranges of quantitative indicators in groups. Data were considered statistically significant at p<0.05.

Results. All patients achieved target glycemic values. In the GD group I, 29 (64.4%) patients received only non-drug therapy, while 16 (35.6%) used diet therapy in combination with insulin administration. In the GD group II, 16 (37.2%) patients received only non-drug therapy, 27 (62.8%) pregnant women used diet therapy in combination with insulin therapy. In the GD II group, patients were significantly less likely to use whole grain products in their diet compared to pregnant women in the GD group and β-cell defect: 6 (14%) patients versus 12 (27%), p=0.03, more often consumed foods with added sugar: 14 (33%) versus 4 (9%), p=0.04 in the GD group I.

Conclusion. Patients with GD and β-cell dysfunction more often achieve GD compensation with non-drug treatment, while patients with GD and IR more often require insulin therapy.