Drexel H, Bichler A, Sailer S, Breier C, Lisch H J, Braunsteiner H, Patsch J R
Department of Medicine, University of Innsbruck, Austria.
Diabetes Care. 1988 Nov-Dec;11(10):761-8. doi: 10.2337/diacare.11.10.761.
In a prospective controlled trial, we studied the effect of tight metabolic control on the outcomes of 102 gestational diabetes mellitus (GDM) pregnancies compared with outcomes of 102 matched nondiabetic control pregnancies. Women with GDM were treated to achieve and maintain a blood glucose concentration of less than 130 mg/dl at 1 h after breakfast. Treatment consisted of a diet low in oligosaccharides and fat and, if necessary, once daily insulin. By the end of gestation, 88 of the 102 women with GDM received insulin at a mean dose of 18 U/day. Duration of insulin therapy ranged from 3 to 32 wk with a median of 11 wk. Perinatal outcome of GDM pregnancies under this management equaled that of control pregnancies. The full spectrum of excess morbidity from GDM was prevented, and normal distribution of birth weight and normal rates of macrosomia, dystrophy, hypoglycemia, hypocalcemia, hyperbilirubinemia, fetal acidosis, and low Apgar scores were achieved. No mortality was observed. In addition to the two main study groups, we also studied a third group of 24 women with GDM whose treatment lasted less than or equal to 5 wk due to late diagnosis. This suboptimally treated group demonstrated a significant (P less than .05) increase of macrosomia and umbilical artery acidosis compared with the well-treated GDM group. The study reported herein demonstrates that excess mortality and morbidity typically observed in GDM can be prevented by early institution of tight metabolic control, which required insulin in 86% of our patients.
在一项前瞻性对照试验中，我们研究了严格代谢控制对102例妊娠期糖尿病（GDM）妊娠结局的影响，并与102例匹配的非糖尿病对照妊娠的结局进行比较。患有GDM的女性接受治疗，以使早餐后1小时血糖浓度达到并维持在低于130mg/dl。治疗包括低聚糖和脂肪含量低的饮食，必要时每日注射一次胰岛素。到妊娠结束时，102例患有GDM的女性中有88例接受了胰岛素治疗，平均剂量为18U/天。胰岛素治疗持续时间为3至32周，中位数为11周。在这种管理下，GDM妊娠的围产期结局与对照妊娠相当。GDM所有的额外发病情况都得到了预防，实现了出生体重的正态分布以及巨大儿、营养不良、低血糖、低钙血症、高胆红素血症、胎儿酸中毒和低Apgar评分的正常发生率。未观察到死亡情况。除了两个主要研究组外，我们还研究了第三组24例患有GDM的女性，由于诊断较晚，她们的治疗持续时间小于或等于5周。与治疗良好的GDM组相比，这个治疗不充分的组显示巨大儿和脐动脉酸中毒显著增加（P<0.05）。本文报道的研究表明，通过早期实施严格的代谢控制，可以预防GDM中通常观察到的额外死亡率和发病率，在我们86%的患者中这需要胰岛素治疗。
