Summary
Diabetes Mellitus (DM) is a chronic metabolic disease resulting from elevated blood glucose levels due to impaired insulin secretion or action. Type 1 diabetes (T1D) is most common in children and adolescents and is also known as juvenile or insulin-dependent diabetes (Bimstein et al., 2019). The disease is characterized by the pancreas almost not producing its own insulin, which leads to an increase in glucose levels in the blood. T1D is not exclusively juvenile as it can develop at any age (Bimstein et al., 2019). Type 2 diabetes (T2D) occurs due to beta-cell dysfunction and insulin resistance in the target tissues (Chatterjee et al., 2017). Along with T1D and T2D, there is diabetes, which occurs among pregnant women, called gestational diabetes (GD).
Any degree of hyperglycemia that occurs during pregnancy is considered GD. The diagnosis includes both previously undiagnosed T2D and GD itself, which develops in the later stages of pregnancy (Dirar & Doupis, 2017). The cause of the development of the disease can be a varying degree of adipocytokine production or increased production of diabetogenic placental hormones (Dirar & Doupis, 2017). Pregnancy is a complex metabolic process that puts additional pressure on beta cells (McIntyre et al., 2019). Various risk factors, such as genetic predisposition, obesity, and age, increase the risk of developing the disease.
Dietary Recommendation for GD
To prevent short-term neonatal and maternal complications due to GD, lifestyle changes are recommended first, including changes in diet and physical activity patterns. Patients with GD are advised to maintain a balanced, healthy diet including sufficient amounts of whole fruits and vegetables, moderate amounts of fiber and fat, and avoid sugar-rich foods (Gestational diabetes diet, n.d.). The daily ration should contain three meals and additional snacks which should not be skipped.
Metformin for GD
Metformin is a biguanide that reduces the excretion of glucose from the liver, decreases its absorption, and increases its absorption in the muscles and adipocyte cells. It also stimulates the secretion of glucagon-like peptide 1 (GLP-1) from intestinal cells (Mukerji & Feig, 2017). Administration includes a liquid to take orally 1-2 times a day with a meal or regular tablets to take 2-3 times a day with a meal or an extended-release tablet to take once a day with an evening meal (Metformin, n.d.). Preparation for a drug administration consists of measuring blood sugar levels 2-3 times a day before meals. The recommended dosage is 500 mg, with a subsequent increase in later pregnancy. With pharmacotherapeutic intervention, a permanent decrease in the patient’s blood glucose level is expected.
Short-term and Long-term Impact of GD and Metformin
GM is primarily associated with an increase in fetal weight, which can lead to birth trauma. Other short-term impacts may be neonatal hyperglycemia in the immediate postpartum period and an increased risk of respiratory distress (Murray & Reynolds, 2020). GM’s long-term impacts include an increased likelihood of developing obesity and cardiovascular diseases, circulatory system pathologies, and increased rates of insulin resistance (Murray & Reynolds, 2020). Changes which occurred in childhood due to the mother’s GM are likely to persist throughout adulthood.
In a short-term study of two groups of 751 pregnant women, the first group took Metformin 500 mg 1–2 times daily. At a later date, the dosage was increased to 2500 mg per day with the additional insulin when glycemic levels were not reached (Mukerji & Feig, 2017). The second group of subjects received only insulin as a traditional method of therapy. The study found no difference in the neonatal morbidity rate; severe neonatal hypoglycemia was less common, although preterm labor was more common; 46.3% of women required insulin in addition to Metformin (Mukerji & Feig, 2017). Long-term studies found that mothers who received Metformin in late pregnancy had more triglycerides, which affected fat accumulation in infants. Studies did not show significant differences between children from the first and second groups in social, linguistic, and motor skills at the age of 18 months (Mukerji & Feig, 2017). However, children of mothers taking Metformin are significantly taller and heavier than children in the second group.
References
Bimstein, E., Zangen, D., Abedrahim, W., & Katz, J. (2019). Type 1 diabetes mellitus (juvenile diabetes) – A review for the pediatric oral health provider. The Journal of Clinical Pediatric Dentistry, 43(6), 417-423. Web.
Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes.Seminar, 389(10085), 1-13. Web.
Dirar, A., & Doupis, J. (2017). Gestational diabetes from A to Z.World of Diabetes, 8(12), 489-506. Web.
Gestational diabetes diet. (n.d.). MedlinePlus. Web.
McIntyre, D., Catalano, P., Zhang, C., Desoye, G., Mathiesen, E., & Damm, P. (2019). Gestational diabetes mellitus.Nature Reviews Disease Primers, 5(1), 1-19. Web.
Metformin. (n.d.). MedlinePlus. Web.
Mukerji, G., & Feig, D. S. (2017). Pharmacological management of gestational diabetes Mellitus.Drugs, 77(16), 1723-1732. Web.
Murray, S. R., & Reynolds, R. M. (2020). Short‐ and long‐term outcomes of gestational diabetes and its treatment on fetal development.Prenatal Diagnosis, 40(2), 1085-1091. Web.