POSTPRANDIAL VERSUS PREPRANDIAL BLOOD-GLUCOSE MONITORING IN WOMAN WITH GESTATIONAL DIABETES-MELLITUS REQUIRING INSULIN THERAPY

Background. The fetuses of women with gestational diabetes mellitus ar e at risk for macrosomia and its attendant complications, The best met hod of achieving euglycemia in these women and reducing morbidity in t heir infants is not known, We compared the efficacy of postprandial an d preprandial monitoring in achieving glycemic control in women with g estational diabetes. Methods. We studied 66 women with gestational dia betes mellitus who required insulin therapy at 30 weeks of gestation o r earlier, The women were randomly assigned to have their diabetes man aged according to the results of preprandial monitoring or postprandia l monitoring (one hour after meals) of blood glucose concentrations, B oth groups were also monitored with fasting blood glucose measurements . The goal of insulin therapy was a preprandial value of 60 to 105 mg per deciliter (3.3 to 5.9 mmol per liter) or a postprandial value of l ess than 140 mg per deciliter (7.8 mmol per liter). Obstetrical data a nd information on neonatal outcomes were collected. Results. The prepr egnancy weight, weight gain during pregnancy, gestational age at the d iagnosis of diabetes and at delivery, degree of compliance with therap y, and degree of achievement of target blood glucose concentrations we re similar in the two groups, The mean (+/- SD),change in the glycosyl ated hemoglobin value was greater in the group in which postprandial m easurements were used (-3.0+/-2.2 percent vs, -0.6+/-1.6 percent, P<0. 001) and the infants' birth weight was lower (3469+/-668 vs, 3848+/-43 4 g, P=0.01). Similarly, the infants born to the women in the postpran dial-monitoring group had a lower rate of neonatal hypoglycemia (3 per cent vs, 21 percent, P=0.05), were less often large for gestational ag e (12 percent vs. 42 percent, P=0.01) and were less often delivered by cesarean section because of cephalopelvic disproportion (12 percent v s. 36 percent, P=0.04) than those in the preprandial-monitoring group. Conclusions. Adjustment of insulin therapy in women with gestational diabetes according to the results of postprandial, rather than prepran dial, blood glucose values improves glycemic control and decreases the risk of neonatal hypoglycemia, macrosomia, and cesarean delivery.