Gestasyonel Diyabetes Mellitus Hastalarında Doğum Sonrası Tip 2 Diyabet Sıklığı

Year 2023, Volume: 7 Issue: 2, 132 - 136, 29.10.2023

Lezzan Keskin

https://doi.org/10.30565/medalanya.1295353

Abstract

Amaç: Çalışmamızda postpartum dönemde tip 2 diabetes mellitus (DM) sıklığı ve risk faktörleri ile ilişkisinin incelenmesi amaçlanmıştır.

Gereç ve Yöntem: Malatya Turgut Özal Üniversitesi, Malatya Eğitim ve Araştırma Hastanesi Endokrinoloji polikliniğinde gestasyonel diyabet tanısı alan, takip ve tedavisi edilen ve postpartum Oral Glikoz Tolerans Testi (OGTT) yapılan hastalar dahil edilmiştir.

Bulgular: Çalışmaya 157 hasta dahil edildi. Yaş ortalaması 31,8±5,6 idi. Gebelik boyunca takibi ve tedavisi ile izlendikten sonra postpartum 8. haftada 75 gramlık OGTT yapıldı. Yirmi üç hastada (%14,64) bozulmuş glikoz toleransı (BGT), 18 hastada (%11,46) bozulmuş açlık glikozu (BAG) ve 17 hastada (%10,8) tip 2 DM tespit edilmiş olup 99 hastamızın (%63,5) normal glikoz değerleri tespit edilmiştir. Postpartum dönemde DM varlığı açısından değerlendirildiğinde anamnezinde gestasyonel DM öyküsü (p=0,305) ve aile öyküsü varlığı ya da yokluğu açısından farklılık saptanmadı (p=0,095). DM varlığı açısından insülin tedavisi alan hastalar ile diyet tedavisi alan hastalar arasında ise anlamlı farklılık vardı (p=0,001).

Sonuç: Çalışmamızın sonucunda postpartum dönemde tip 2 DM gelişiminin anne yaşının yüksekliği ve vücut kitle indeksi (VKİ) artışının beraberliği ile ilişkili olduğunu söyleyebiliriz. Yaşam şekli değişikliği ile sağlanacak ideal kilo ile gebe kalmak tip 2 DM riskin ve uzun vadede diyabete bağlı komplikasyonlarda azalma gösterebilecektir.

Keywords

Diyabet, gebelik, obezite, insülin

Supporting Institution

yok

Project Number

yok

Thanks

YAZIMIZ 6. SBÜ İÇ HASTALIKLARI KONGRESİNDE SÖZLÜ BİLDİRİ 3. LÜK ÖDÜLÜ ALMIŞ OLUP EKTE BULUNMAKTADIR.

Postpartum Type 2 Diabetes Mellitus Frequency of Patients with Gestational Diabetes Mellitus

Abstract

Aim: This study aims to examine the frequency of type 2 diabetes mellitus (DM) in the postpartum period and its relationship with other risk factors.

Materials and Methods: Patients who were diagnosed, followed up and treated for gestational diabetes in Malatya Turgut Özal University, Malatya Training and Research Hospital Endocrinology outpatient clinic and who underwent Oral Glucose Tolerance Test (OGTT) in the postpartum period were included.

Results: In our retrospective study, 157 patients were included. The mean age was 31.8±5.6 years. After being followed up with her follow-up and treatment throughout the pregnancy, OGTT administered with 75 grams of glucose was performed at the postpartum 8th week. Impaired glucose tolerance (IGT) was detected in 23 patients (14.64%), impaired fasting glucose (IFG) in 18 patients (11.46%), and type 2 DM in 17 patients (10.8%). When evaluated in terms of the presence of DM in the postpartum period, no difference was found regarding the history of gestational DM in the anamnesis (p=0.305) and the presence or absence of family history (p=0.095). In terms of the presence of DM, there was a significant difference between the patients receiving insulin therapy and those receiving diet therapy (p=0.001).

Conclusion: We can say that type 2 DM development in the postpartum period is associated with high maternal age and an increase in body mass index (BMI). Being pregnant with the ideal weight to be achieved by lifestyle changes may decrease the risk of type 2 DM and diabetes-related complications in the long term.

Keywords

diabetes, gestational, obesity, insulin

Project Number

yok

References

• 1. Standards of Medical Care in Diabetes—2016 Abridged for Primary Care Providers. American Diabetes Association. Clin Diabetes. 2016 . 34(1): 3–21. 10.2337/diaclin.34.1.3
• 2. Diagnosis and classification of diabetes mellitus. American Diabetes Association Diabetes Care. 2014; 37: 81-90. https://doi.org/10.2337/dc14-S081
• 3. Coustan DR, Lowe LP, Metzger BE, Dyer AR. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study; paving the way for new diagnostic criteria for gestational diabetes mellitus. Am J Obstet Gynecol. 2010;202(6):654.e1-6. doi: 10.1016/j.ajog.2010.04.006.
• 4. Mulla WR, Henry TQ, Homko CJ. Gestational diabetes screening after HAPO: has anything changed? Curr Diab Rep. 2010;10(3):224-8. doi: 10.1007/s11892-010-0109-3.
• 5. Shaat N, Groop L. Genetics of gestational diabetes mellitus. Curr Med Chem. 2007;14(5):569-83. doi: 10.2174/092986707780059643.
• 6. Kühl C. Insulin secretion ,and insulin resistance in pregnancy and GDM; implications for diagnosis and management. Diabetes. 1991;40 Suppl 2:18-24. doi: 10.2337/diab.40.2.s18.
• 7. Özuğuz U, Aydın Y, Berker D. Gestational Diabetes Mellitus: Risk Factors, Diagnose and Treatment. İç Hastalıkları Dergisi. 2010;17(2):71-79.
• 8. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and metaanalysis. Lancet. 2009:373(9677);1773-9. doi: 10.1016/S0140-6736(09)60731-5.
• 9. Perinatoloji Uzmanları Derneği(PUDER) Gebelik ve Diyabet Kılavuzu 2019. http://puder.org.tr/wp-content/uploads/2019/12/PUDER-Gebelik-ve-Diyabet-K%C4%B1lavuzu-6.10.2019.pdf. Access: 1 Mayıs 2023.
• 10. Jiwani A, Marseille E, Lohse N, Damn P, Hod M, andKahn JG. Gestational Diabetes mellitus : results from a survey of country prevalence and practices. J Matern Fetal Neonatal Med. 2012;25 (6):600-10. doi: 10.3109/14767058.2011.587921.
• 11. Öztürk FY, Altuntaş Y. Gestational diabetes mellitus. The Medical Bulletin of Şişli Etfal Hospital. 2015;49(1):1-10. doi: 10.5350/SEMB.20150317014238
• 12. Özay ÖE, Özay AC, Edebal O, Tunççağ F. Gestational Diabetes and Related Factors: A Retrospective Study. Turkish Journal of Reproductive Medicine and Surgery. 2020;4(2):43-46. doi: 10.24074/tjrms.2020-80531.
• 13. Saezde-de- Ibarra L, Gaspar R, Obesso A, Herranz L. Glycaemic behaviour during lactation: Postpartum Practical guidelines for women with type 1diabetes. Pract Diab Int. 2003;20(8):271-5. doi: 10.1002/pdi.529.
• 14. Garner PR. Type I diabetes and pregnancy. Lancet 1995; 346:157-61. Doi:10.1016/s0140-6736(95)91213-4
• 15. Lin CH,Wen SF, Wu YH, Huang YY, Huang MJ. The postpartum metabolic outcome of women with previous gestational diabetes mellitus. Chang Gung Med J. 2005;28(11):794-800. PMID: 16422186
• 16. Picon MJ, Murri M, Munoz A, Fernandez- Garcia JC, Gomez- Huelgas R, Tinahones FJ. Hemoglobin A1c versus oral glucose tolerance test in postpartum diabetes screening. Diabetes Care. 2012;35(8):1648- 53. doi: 10.2337/dc11-2111.
• 17. Kerimoğlu OS, Yalvaç S, Karçaaltınçaba D, Kandemir Ö. İncidence of diabetes mellitus at postpartum six to twelve months following the diagnosis of gestational diabetes mellitus. J Turk Ger Gynecol Assoc. 2010;11(2):89-94. doi: 10.5152/jtgga.2010.06.
• 18. Bentley-Lewis R, Levkoff S, Stuebe A, Seeley EW. Gestational Diabetes meliitus : Postpartum opportunities fort he diagnosis and prevention of Type 2 diabetes mellitus. Nat Clin Pract Endocrinol Metab. 2008;4(10):552-8. doi: 10.1038/ncpendmet0965.
• 19. Türker F, Türker BC, Ahbab S, Ataoğlu E. Evaluation of Metabolic Parameters of Gestational Diabetic Patients in Postpartum Period. Med Bull Haseki. 2018;56:136-9. doi: 10.4274/haseki.25733
• 20. Diabetes in pregnancy: management from preconception to the postnatal perid NICE guideline Published: 25 February 2015. https://www.nice.org.uk/guidance/ng3/resources/diabetes-in-pregnancy-management-from-preconception-to-the-postnatal-period-pdf-51038446021 Access: 1 Mayıs 2023.
• 21. Krishnaveni GV, Hill JC, Veena SR, Geetha S, Jayakumar MN, Karat CL, et al. Gestational diabetes and the incidence of diabetes in the 5 years following the index pregnancy in South Indian women. Diabetes Res Clin Pract. 2007;78(3):398-404. doi: 10.1016/j.diabres.2007.06.002.