Dainelli Livia, Prieto-Patron Alberto, Silva-Zolezzi Irma, Sosa-Rubi Sandra G, Espino Y Sosa Salvador, Reyes-Muñoz Enrique, Lopez-Ridaura Ruy, Detzel Patrick
Nestlé Research Center, Lausanne, Switzerland.
Health Economics Department, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
Diabetes Metab Syndr Obes. 2018 Apr 5;11:105-116. doi: 10.2147/DMSO.S160658. eCollection 2018.
To identify the most common practices implemented for the screening and treatment of gestational diabetes mellitus (GDM) and to estimate the GDM clinician-reported proportion as a proxy of the incidence in Mexico.
Three hundred fifty-seven physicians in four major cities were asked about their practices regarding GDM screening, treatment, clinical exams, and health care staff involved in case of GDM diagnosis, as well as the percentage of women with GDM they care for. Data management and statistical analyses were done with Stata 13.
The overall GDM clinician-reported proportion was 23.7%. Regional differences were expected and consistent with the data on the epidemiology of the obesity in the country. The most common screening test was the oral glucose tolerance test 75 g one step (46.6% of total cases). Diet and exercise were sufficient to treat GDM in 40.6% of cases; the rest of the sample relied on some form of medication, especially oral hypoglycemic agents (63.0% of cases), insulin (22.0%), or a combination of these (13.0%). To educate women on how to measure glycemia and eventually take medications, an average of 2-3 hours were necessary. The three most common prenatal screening tests were the "no stress", the "Doppler ultrasound", and the "biophysical profile", respectively, taken at least once by 70%, 60%, and 45% of women. Among women who were prescribed insulin, only 37% managed to keep the initial prescribed dose during the whole pregnancy.
The survey confirmed the expected incidence and gave interesting results on the treatment of GDM. The current Mexican guidelines seem to have been partially implemented in practice, and a coherent national strategy for GDM is still missing. More studies are encouraged to investigate this topic, with the aim to better understand the importance of the monetary cost of GDM, which is currently underestimated.
确定用于妊娠期糖尿病（GDM）筛查和治疗的最常见做法，并估算临床医生报告的GDM比例，以此作为墨西哥发病率的一个指标。
询问了四个主要城市的357名医生关于他们在GDM筛查、治疗、临床检查以及GDM诊断时涉及的医护人员等方面的做法，以及他们所诊治的GDM女性患者的比例。使用Stata 13进行数据管理和统计分析。
临床医生报告的GDM总体比例为23.7%。存在地区差异，这与该国肥胖流行病学数据相符。最常用的筛查测试是75克一步法口服葡萄糖耐量试验（占总病例的46.6%）。40.6%的病例通过饮食和运动足以治疗GDM；其余病例则依赖某种形式的药物治疗，尤其是口服降糖药（占病例的63.0%）、胰岛素（22.0%）或两者联合使用（13.0%）。为了指导女性如何测量血糖并最终用药，平均需要2至3小时。三种最常见的产前筛查测试分别是“无应激试验”、“多普勒超声检查”和“生物物理评分”，至少70%、60%和45% 的女性各进行过一次。在使用胰岛素治疗的女性中，只有37% 在整个孕期维持了初始规定剂量。
该调查证实了预期的发病率，并给出了关于GDM治疗的有趣结果。当前墨西哥的指南似乎在实践中得到了部分实施，但仍缺乏一个连贯的全国性GDM战略。鼓励开展更多研究来调查这一主题，以便更好地理解GDM货币成本目前被低估的重要性问题。
