학술논문
Precision gestational diabetes treatment: a systematic review and meta-analyses.
Document Type
Academic Journal
Author
Benham JL; Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.; Gingras V; Department of Nutrition, Université de Montréal, Montreal, QC, Canada.; Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada.; McLennan NM; MRC Centre for Reproductive Health, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK.; Centre for Cardiovascular Science, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK.; Most J; Department of Orthopedics, Zuyderland Medical Center, Sittard-Geleen, The Netherlands.; Yamamoto JM; Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.; Aiken CE; Department of Obstetrics and Gynaecology, the Rosie Hospital, Cambridge, UK.; NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK.; Ozanne SE; University of Cambridge Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Wellcome-MRC Institute of Metabolic Science, Cambridge, UK.; Reynolds RM; MRC Centre for Reproductive Health, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK. r.reynolds@ed.ac.uk.; Centre for Cardiovascular Science, Queens's Medical Research Institute, University of Edinburgh, Edinburgh, UK. r.reynolds@ed.ac.uk.
Source
Publisher: Nature Portfolio Country of Publication: England NLM ID: 9918250414506676 Publication Model: Electronic Cited Medium: Internet ISSN: 2730-664X (Electronic) Linking ISSN: 2730664X NLM ISO Abbreviation: Commun Med (Lond) Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
Background: Gestational Diabetes Mellitus (GDM) affects approximately 1 in 7 pregnancies globally. It is associated with short- and long-term risks for both mother and baby. Therefore, optimizing treatment to effectively treat the condition has wide-ranging beneficial effects. However, despite the known heterogeneity in GDM, treatment guidelines and approaches are generally standardized. We hypothesized that a precision medicine approach could be a tool for risk-stratification of women to streamline successful GDM management. With the relatively short timeframe available to treat GDM, commencing effective therapy earlier, with more rapid normalization of hyperglycaemia, could have benefits for both mother and fetus.
Methods: We conducted two systematic reviews, to identify precision markers that may predict effective lifestyle and pharmacological interventions.
Results: There was a paucity of studies examining precision lifestyle-based interventions for GDM highlighting the pressing need for further research in this area. We found a number of precision markers identified from routine clinical measures that may enable earlier identification of those requiring escalation of pharmacological therapy (to metformin, sulphonylureas or insulin). This included previous history of GDM, Body Mass Index and blood glucose concentrations at diagnosis.
Conclusions: Clinical measurements at diagnosis could potentially be used as precision markers in the treatment of GDM. Whether there are other sensitive markers that could be identified using more complex individual-level data, such as omics, and if these can feasibly be implemented in clinical practice remains unknown. These will be important to consider in future studies.
(© 2023. Springer Nature Limited.)
Methods: We conducted two systematic reviews, to identify precision markers that may predict effective lifestyle and pharmacological interventions.
Results: There was a paucity of studies examining precision lifestyle-based interventions for GDM highlighting the pressing need for further research in this area. We found a number of precision markers identified from routine clinical measures that may enable earlier identification of those requiring escalation of pharmacological therapy (to metformin, sulphonylureas or insulin). This included previous history of GDM, Body Mass Index and blood glucose concentrations at diagnosis.
Conclusions: Clinical measurements at diagnosis could potentially be used as precision markers in the treatment of GDM. Whether there are other sensitive markers that could be identified using more complex individual-level data, such as omics, and if these can feasibly be implemented in clinical practice remains unknown. These will be important to consider in future studies.
(© 2023. Springer Nature Limited.)