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Gestational Diabetes Management

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4801. Glyburide Compared to Insulin in the Management of White's Classification A2 Gestational Diabetes

Glyburide Compared to Insulin in the Management of White's Classification A2 Gestational Diabetes Glyburide Compared to Insulin in the Management of White's Classification A2 Gestational Diabetes - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove (...) one or more studies before adding more. Glyburide Compared to Insulin in the Management of White's Classification A2 Gestational Diabetes The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT00160485 Recruitment Status : Withdrawn (Active Duty principle investigator currently deployed) First Posted

2005 Clinical Trials

4802. Glyburide for the management of gestational diabetes: risk factors predictive of failure and associated pregnancy outcomes. (PubMed)

Glyburide for the management of gestational diabetes: risk factors predictive of failure and associated pregnancy outcomes. The purpose of this study was to identify characteristics that may predict failure of glyburide therapy for the management of A2 gestational diabetes, and to evaluate whether those that fail are at increased risk for adverse pregnancy outcomes.This was a retrospective cohort of gestational diabetics requiring medical therapy (A2DM) treated between January 2002 and July (...) 2005.Of the 235 gestational diabetics identified, 79% of the 101 A2DMs were successfully treated with glyburide as first-line therapy. Those that failed had a higher mean glucose value on glucose challenge test (GCT) (200.5 +/- 57.3 vs 176.6 +/- 33.8 mg/dL, P = .019) and were more likely to have a GCT > or = 200 mg/dL (45 vs 22%, P = .043). Only GCT and GCT > or = 200 mg/dL were predictive of failure. Those successfully managed with glyburide had increased NICU admissions, primarily

2006 American Journal of Obstetrics and Gynecology

4803. Obstetric management in gestational diabetes. (PubMed)

Obstetric management in gestational diabetes. Reviewing the areas of controversy related to the obstetric management of women with GDM, we are unfortunately unable to provide significant refinement of the recommendations agreed upon after the Fourth International Workshop-Conference due to the lack of properly controlled and powered clinical studies in this area since 1997. In the area of the need for antenatal fetal surveillance in women with milder degrees of GDM, we may be able to draw (...) to be of benefit in the obstetric management of women with GDM.

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2007 Diabetes Care

4804. Pharmacological management of gestational diabetes: an overview. (PubMed)

Pharmacological management of gestational diabetes: an overview. To provide a review of the background literature regarding the pharmacological management of gestational diabetes.This is a literature review.Information is available regarding the use of some, but not all, oral antidiabetes agents in pregnancy.Available evidence supports the use of glyburide during pregnancy. Evidence is inadequate to support or refute the use of metformin, an agent that has been shown to cross the placenta

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2007 Diabetes Care

4805. Nurse-based management in patients with gestational diabetes. (PubMed)

Nurse-based management in patients with gestational diabetes. To compare the rate of insulin treatment and perinatal outcome in women with gestational diabetes mellitus (GDM) under endocrinologist-based versus diabetes nurse-based metabolic management.In a retrospective analysis, maternal characteristics, rate of insulin treatment, and perinatal outcome of patients with GDM delivering between 1 January 1995 and 30 June 1997 (n = 244) receiving endocrinologist-based care were compared with those (...) delivering between 1 July 1997 and 31 December 1999 (n = 283) who received diabetes nurse-based care. The diabetes nurse's role was similar to that of an advanced practice nurse in the U.S. There were no changes in the metabolic goals and instruments or in obstetric and neonatal management. Quantitative data were compared with the Mann-Whitney U test and categorical data, with Fisher's exact test.Maternal characteristics (age, BMI, family history of diabetes, prior glucose intolerance, gestational age

2003 Diabetes Care

4806. Comparison of glyburide versus insulin in management of gestational diabetes mellitus. (PubMed)

Comparison of glyburide versus insulin in management of gestational diabetes mellitus. 17669723 2007 09 06 2013 11 21 1934-2403 13 4 2007 Jul-Aug Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists Endocr Pract Comparison of glyburide versus insulin in management of gestational diabetes mellitus. 427-8 Ogunyemi Dotun D Jesse Marquis M Davidson Mayer M eng Comment Comparative Study Letter Randomized Controlled (...) Trial United States Endocr Pract 9607439 1530-891X 0 Hypoglycemic Agents 0 Insulin SX6K58TVWC Glyburide IM N Engl J Med. 2000 Oct 19;343(16):1134-8 11036118 Diabetes, Gestational drug therapy Drug Costs Female Glyburide adverse effects economics therapeutic use Humans Hypoglycemic Agents adverse effects economics therapeutic use Insulin economics therapeutic use Pregnancy 2007 8 3 9 0 2007 9 7 9 0 2007 8 3 9 0 ppublish 17669723 P3WH54725185Q345 10.4158/EP.13.4.427

2007 Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists Controlled trial quality: uncertain

4807. A randomized trial evaluating a predominantly fetal growth-based strategy to guide management of gestational diabetes in Caucasian women. (PubMed)

A randomized trial evaluating a predominantly fetal growth-based strategy to guide management of gestational diabetes in Caucasian women. To compare the management of Caucasian women with gestational diabetes (GDM) based predominantly on monthly fetal growth ultrasound examinations with an approach based solely on maternal glycemia.Women with GDM who attained fasting capillary glucose (FCG) <120 mg/dl and 2-h postprandial capillary glucose (2h-CG) <200 mg/dl after 1 week of diet were randomized (...) to management based on maternal glycemia alone (standard) or glycemia plus ultrasound. In the standard group, insulin was initiated if FCG was repeatedly >90 mg/dl or 2h-CG was >120 mg/dl. In the ultrasound group, thresholds were 120 and 200 mg/dl, respectively, or a fetal abdominal circumference >75th percentile (AC>p75). Outcome criteria were rates of C-section, small-for-gestational-age (SGA) or large-for-gestational-age (LGA) infants, neonatal hypoglycemia (<40 mg/dl), and neonatal care

2004 Diabetes Care Controlled trial quality: uncertain

4808. Advice that includes food sources of unsaturated fat supports future risk management of gestational diabetes mellitus. (PubMed)

Advice that includes food sources of unsaturated fat supports future risk management of gestational diabetes mellitus. Abstract Women with gestational diabetes mellitus (GDM) have a greater risk of developing type 2 diabetes mellitus (DM) and heart disease than pregnant women without GDM. Advice given during the GDM pregnancy provides an opportunity to develop protective dietary patterns for the long-term management of this risk. Dietary guidelines for the prevention and management of type 2 DM

2004 Journal of the American Dietetic Association Controlled trial quality: uncertain

4809. Use of an internet-based telemedicine system to manage underserved women with gestational diabetes mellitus. (PubMed)

Use of an internet-based telemedicine system to manage underserved women with gestational diabetes mellitus. Internet technology has been proven to be a successful tool for the management of patients with multiple medical conditions. The purpose of this study was to demonstrate the feasibility of monitoring glucose control in indigent women with gestational diabetes mellitus (GDM) over the Internet.Women with GDM were randomized to either the Internet group (n = 32) or the control group (n = 25 (...) ). Patients in the Internet group were provided with computers and/or Internet access if needed. A website was established for documentation of glucose values and communication between the patient and the health care team. Women in the control group maintained paper logbooks, which were reviewed at each prenatal visit. Maternal feelings of diabetes self-efficacy were assessed at study entry and again before delivery.Women in the Internet group accessed the system and sent on average 21.8 (+/- 16.9) sets

2007 Diabetes technology & therapeutics Controlled trial quality: uncertain

4810. Metformin and insulin in the management of gestational diabetes mellitus: preliminary results of a comparison. (PubMed)

Metformin and insulin in the management of gestational diabetes mellitus: preliminary results of a comparison. To compare glycemic control and neonatal outcomes in women with gestational diabetes mellitus (GDM) treated with metformin vs. insulin.Women with GDM not controlled with diet and exercise were randomized to metformin (n = 32) or insulin (n = 31). The levels of glycemic control as well as maternal/neonatal complications were evaluated.The mean (+/- SD) fasting and 2-hour postprandial (...) blood glucose did not differ statistically between the 2 treatment groups. No patient failed metformin and required insulin. The majority (27/32) were easily controlled on the initial dosage (500 mg twice a day). Gestational age at entry and delivery (p = 0.077, 0.412) were similar. The difference in the rate of cesarean delivery was not statistically significant between the 2 groups (p = 0.102). Neonatal statistics were also not different between the metformin and insulin groups: birth weight

2007 Journal of Reproductive Medicine Controlled trial quality: uncertain

4811. Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization. (PubMed)

Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization. This study was undertaken to compare the use of glyburide with insulin for the treatment of gestational diabetes mellitus (GDM) unresponsive to diet therapy.A retrospective study was performed among women with singleton pregnancies who had GDM diagnosed, with fasting plasma glucose 140 mg/dL or less on glucose tolerance testing, between 12 and 34 weeks who failed diet therapy (...) treated with insulin and 137 women treated with glyburide. More women in the glyburide group achieved mean fasting and postprandial goals (86%, 63%, P<.001). These findings remained significant in logistic regression analysis.In a large managed care organization, glyburide was at least as effective as insulin in achieving glycemic control and similar birth weights in women with GDM who failed diet therapy. The increased risk of preeclampsia and phototherapy in the glyburide group warrant further study.

2005 American Journal of Obstetrics and Gynecology

4812. Assessment of costs and benefits of management of gestational diabetes mellitus. (PubMed)

Assessment of costs and benefits of management of gestational diabetes mellitus. The purpose of this pilot study was to perform a cost-identification analysis of care for gestational diabetes mellitus (GDM) by determining the direct costs of the diagnostic procedures and treatment used for the outpatient management of GDM (program input costs) and the direct costs of maternal hospitalization after diagnosis of GDM, delivery of the baby, and newborn care (outcome costs). Reimbursed average (...) charges in the Northern California (NoCal) managed care market in 1996 were used to establish the direct costs, and the direct costs were then applied to the elements of care and pregnancy outcomes of three GDM management programs in NoCal, Southern California (SoCal), and New England (NewEng), using prospectively collected data. Reimbursed amounts for the detailed elements of GDM management (program input costs) are presented in the categories of diagnosis of GDM, diabetes treatment supplies

1998 Diabetes Care

4813. A proposal for detecting and managing gestational diabetes by coordinating existing services. (PubMed)

A proposal for detecting and managing gestational diabetes by coordinating existing services. A significant improvement in the quality of births by low-income women can be achieved by implementing a low-cost screening procedure and by coordinating private and public sector services that these women may already be receiving. This proposal outlines a screening program for gestational diabetes, coupled with multidisciplinary team management of this disorder through cooperative efforts of private

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1986 Public Health Reports

4814. Detecting and managing gestational diabetes. (PubMed)

Detecting and managing gestational diabetes. Gestational diabetes is an asymptomatic metabolic disorder of pregnancy associated with increased morbidity in mother and fetus. Early detection and intervention improve pregnancy outcome. This article reviews the current approach to diagnosis and management. Specific guidelines for nutritional management and insulin use are included.

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1993 Canadian Family Physician

4815. Prophylactic insulin in the management of gestational diabetes. (PubMed)

Prophylactic insulin in the management of gestational diabetes. One hundred eight gestational diabetics were randomized to receive either diet alone or diet plus insulin (20 units NPH and 10 units regular) for glycemic control. Blood glucose levels were evaluated weekly in a high-risk clinic where medical and nutritional support and counseling were provided. Among 68 women successfully treated for a minimum of 6 weeks, the mean birth weight, macrosomia rate, and ponderal index were reduced

1990 Obstetrics and Gynecology Controlled trial quality: uncertain

4816. Hypocaloric diets and ketogenesis in the management of obese gestational diabetic women. (PubMed)

Hypocaloric diets and ketogenesis in the management of obese gestational diabetic women. The extent to which given levels of caloric restriction will improve glycemic status but increase plasma ketone bodies in gestational diabetic women has received little attention. After reviewing the underlying physiology, we present data on two feeding studies investigating the question. In the first, a weight-maintaining approximately 2400-kcal/day diet was fed on a metabolic ward to 12 gestational (...) in ketonuria, which is of uncertain significance. An intermediate 33% level of caloric restriction (to 1600-1800 kcal daily) may be more appropriate in dietary management of obese woman with gestational diabetes mellitus and more effective than prophylactic insulin. Further studies are required to confirm these findings.

1991 Journal of the American College of Nutrition Controlled trial quality: uncertain

4817. [Intensified insulin therapy in the management of gestational diabetes]. (PubMed)

[Intensified insulin therapy in the management of gestational diabetes]. A total of 35 pregnancies in 28 Pregestational Diabetic Patients (PDP) were followed with the goal of achieving and maintaining near normoglycemia (as many pre-postprandial glycemias as possible between 60-140 mg/dl); 13 patients (16 pregnancies) were assigned to Subcutaneous Continuous Preprogrammed Insulin Infusion (SCII) because of high risk pregnancies (HRP) (at least one of the following: former history of spontaneous (...) abortions, stillbirths, premature deliveries and/or sterility). The remaining 12 PDP's (15 pregnancies with no past history of the above nature) were treated with Multiple Conventional Insulin Injections (MCII). Both groups were comparable regarding the following clinical parameters: age, time of onset and class of diabetes. All patients were instructed in performing 3 to 7 daily Self Capillary Blood Glucose controls (SCBG). Mean follow-up observation period was (mean +/- SEM) 28.5 +/- 2.5 weeks

1992 Medicina Controlled trial quality: uncertain

4818. Intensified versus conventional management of gestational diabetes. (PubMed)

Intensified versus conventional management of gestational diabetes. We tested the hypothesis that intensified management of gestational diabetes mellitus on the basis of stringent glycemic control, verified glucose data, and adherence to an established criterion for insulin initiation results in near normoglycemia control and reduction of adverse outcomes.A prospective, population-based study compared the effect on perinatal outcome of conventional (n = 1316) and intensified (n = 1145 (...) ) management. Group assignment was based on availability of memory-based reflectance meters at entry to the program. A contemporaneous randomized control group (nondiabetic, n = 4922) was selected.The diabetic groups were comparable in demographic characteristics and in factors associated with higher risk for adverse pregnancy outcome, such as previous macrosomia, previous gestational diabetes mellitus, and family history of diabetes. The control group was younger, less obese, and had a lower rate

1994 American journal of obstetrics and gynecology Controlled trial quality: uncertain

4819. A randomized controlled trial of strict glycemic control and tertiary level obstetric care versus routine obstetric care in the management of gestational diabetes: a pilot study. (PubMed)

A randomized controlled trial of strict glycemic control and tertiary level obstetric care versus routine obstetric care in the management of gestational diabetes: a pilot study. The purpose of this study was to determine whether strict maternal glycemic control for the treatment of gestational diabetes lessened the risk of fetal macrosomia, birth trauma, neonatal hypoglycemia, and operative delivery. The aim of the pilot study was to prepare for a multicenter trial by assessing patient (...) acceptance of the study, by determining realistic accrual rates, and by detecting any major adverse outcomes in the control group that received routine obstetric care.The study was a prospective randomized controlled trial comparing fetal-neonatal and maternal outcomes in 300 women with gestational diabetes. Women randomized to the treatment arm were managed by strict glycemic control and tertiary level obstetric care, and women in the control arm received routine obstetric care.Three hundred women

1997 American journal of obstetrics and gynecology Controlled trial quality: uncertain

4820. Usefulness of a breakfast test in the management of women with gestational diabetes. (PubMed)

Usefulness of a breakfast test in the management of women with gestational diabetes. To assess the usefulness of a breakfast test in determining which women with gestational diabetes do not need self-monitoring of blood glucose levels (home monitoring).A 1-hour post-standardized breakfast blood glucose below 7.8 mmol/L (140 mg/dL) was measured in 227 women and at or above 7.8 mmol/L in 115. Within each group, women were randomized to home monitoring with a meter or to clinic follow-up. Target (...) glucose values were 5.3 mmol/L (95 mg/dL) fasting, 5.6 mmol/L (101 mg/dL) before meals, and 7.8 mmol/L (140 mg/dL) 1 hour postprandial. Up to these thresholds women on clinic follow-up were transferred to home monitoring. Insulin therapy was started on the same thresholds in women randomized or transferred to home monitoring. Large for gestational age (LGA) newborns represented the main outcome, with the transfer rate to home monitoring and need of insulin therapy the secondary ones.The LGA delivery

1997 Obstetrics and Gynecology Controlled trial quality: uncertain

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