Tamás Gyula, Kerényi Zsuzsa
National Centre for Diabetes Care, Semmelweis University, Faculty of Medicine, 1st Department of Medicine, Diabetes Unit, Korànyi Sàndor utca 2A, Budapest H-1083, Hungary.
Curr Diab Rep. 2002 Aug;2(4):337-46. doi: 10.1007/s11892-002-0024-3.
Gestational diabetes mellitus (GDM) is a heterogeneous entity, including carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Insulin resistance and beta-cell dysfunction are thought to be major determinants of its development. Its pathomechanism in many ways resembles that of type 2 diabetes. There is an evolving body of evidence from the last decade presenting similarities between gestational diabetes and the metabolic (insulin resistance) syndrome. These new observations suggest that GDM might be an early manifestation of the metabolic syndrome. The desired treatment target of GDM is normoglycemia. It can be reached by dietary treatment; however, if it fails, maternal glycemic monitoring or combined fetal-maternal monitoring, or even insulin (if required) can help reach it. Multiple daily insulin regimens are becoming more widely accepted for the treatment of GDM. Insulin analogues, however, need some more evidence to support their usefulness and safety during pregnancy. The screening for GDM, the reclassification, regular care, and follow-up of these women after pregnancy are of the utmost importance to delay or prevent not only type 2 diabetes but cardiovascular complications as well.
妊娠期糖尿病（GDM）是一种异质性疾病，包括在妊娠期间发病或首次被识别的不同严重程度的碳水化合物不耐受。胰岛素抵抗和β细胞功能障碍被认为是其发展的主要决定因素。其发病机制在许多方面类似于2型糖尿病。过去十年中不断有证据表明妊娠期糖尿病与代谢（胰岛素抵抗）综合征之间存在相似之处。这些新观察结果表明，GDM可能是代谢综合征的早期表现。GDM的理想治疗目标是血糖正常。通过饮食治疗可以实现这一目标；然而，如果饮食治疗失败，母体血糖监测或联合胎儿-母体监测，甚至必要时使用胰岛素，都有助于实现这一目标。每日多次胰岛素治疗方案在GDM治疗中越来越被广泛接受。然而，胰岛素类似物在孕期的有效性和安全性还需要更多证据支持。对这些女性进行GDM筛查、重新分类、定期护理以及产后随访，对于延迟或预防2型糖尿病以及心血管并发症都至关重要。
