Endocrine Notes: Diabetes and Gestational Diabetes

The results of a study called the NICE-SUGAR study were recently released in the New England Journal of Medicine. Some have interpreted the study to mean that tight glucose (blood sugar) control for hospitalized patients can actually have a negative impact. Several months earlier, results of the ACCORD study were released, which also brought into question the value of tight glucose control, this time in the outpatient setting.

The American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) caution against letting these studies swing the pendulum of glucose control too far in the other direction where providers in hospitals are complacent about uncontrolled hyperglycemia.

However, recognizing the importance of glycemic control across the continuum of care, AACE and the ADA joined forces to develop an updated consensus statement on inpatient glycemic management. After a thorough analysis of all the data from clinical published trials, including the NICE-SUGAR study, AACE and the ADA believe that patients with elevations in blood glucose should continue to be treated, but to less intensive blood glucose targets. The Associations recommend revised glucose targets of 140-180 mg/dL.

The updated recommendations can be found on the AACE Web Site at www.aace.com.

What is Gestational diabetes?

This common condition refers to an inability to “handle” food properly, as a result of the hormones of pregnancy working against the normal effect of insulin, and allowing the sugar in the blood to rise to dangerous levels. It occurs more commonly in women with a family history of diabetes, as well as women from certain ethnic groups, and is worsened by obesity. Often it can be treated by careful diet alone; but, in many cases, treatment with insulin injections will be necessary to protect the baby from the bad effects of the mom’s high blood sugar. These include high birth weights and the need for Cesarean sections, as well as low blood sugar in the baby at birth (hypoglycemia), which can cause seizures. Expectant mothers may be asked to check their own blood sugars after meals with a finger-prick to make sure that therapy is working correctly.

Gestational diabetes is also a strong predictor of type 2 diabetes later in life. This gives a woman a “heads-up” to engage in healthy eating, regular exercise and keeping her weight in the normal range, since all of these things have been shown to actually prevent or delay the onset of diabetes and all of its complications.