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Therapeutic interventions
This review summarizes Session IV: Therapeutic Interventions of the Fourth International Gestational Diabetes Workshop and suggests intervention protocols based on the presentations at this meeting and the literature. The opinions of the six presenters and their interpretation of the review of the literature in their specific areas, the synthesis of the 30 abstracts presented at this symposium on therapeutic interventions, and my interpretations of the literature to date on these strategies are discussed. Also, the suggested intervention protocols are outlined as to medical nutritional therapy, weight gain, insulin prescriptions, and the utility of an exercise program for gestational diabetes mellitus. The goals of an intervention protocol for the gestational diabetic women are to achieve and maintain normoglycemia and thus to minimize the risk of maternal or fetal morbidity.
Abbreviations: GDM gestational diabetes melLitus.
A reviewer of therapeutic options for a given malady makes three assumptions: 1) there is a consensus on definition of the condition, 2) there is agreement on the means of diagnosis, and 3) therapy is warranted. In the case of gestational diabetes mellitus (GDM) or glucose intolerance during gestation, each of these assumptions continues to be challenged. Nevertheless, the clinical approach to the woman with hyperglycemia of first recognition during gestation is becoming increasingly important as women defer childbearing, populations increase in weight, and evidence mounts that even minor perturbations in glucose metabolism during gestation have marked consequences for the mother, the offspring, and subsequent generations.
The Fourth International Gestational Diabetes \Morkshop-Conference devoted the last session to presentations on therapeutic intervention strategies. For purposes of this review, we will also accept the definitions and diagnostic criteria as outlined in the summary statements of this symposium. Therefore, this review will focus on the opinions of the six presenters and their interpretation of the rex iew of the literature in their specific areas, the synthesis of the 30 abstracts presented at this symposium on therapeutic interventions, and my interpretations of the literature to date on these strategies.
The goals for therapy for the GDM woman are to achieve and maintain as near normal glycemia as is feasible. To this end, optimal therapeutic strategies must be safe and efficacious in achieving a metabolic balance without creating complications, which may include...