MD Conference Express ADA 2013 - (Page 9)
Due to the low number of studies and inconsistencies
in reporting metrics, the results for the secondary outcomes
are weak. However, there were trends for reduced risk of
hypoglycemia, improved quality of life, and no changes in
insulin dose, weight, or fasting plasma glucose level. The
literature shows a wide variation in carbohydrate counting
ability with greater accuracy and precision associated with
lower HbA1C levels. However, skill and compliance were
not measured in these studies.
As this analysis shows, carbohydrate counting may not
result in optimal blood glucose control and clinicians need
to realize some patients may fail with this approach. Many
people with T1D have difficulty managing postprandial
blood glucose levels despite their best efforts. In addition,
carbohydrate counting has been linked to unhealthy food
beliefs, fats and protein intake that exceed nutritional
recommendations, and increased reliance on packaged
foods. Clinicians need to emphasize healthy eating with
insulin matched to food choices rather than choosing foods
to limit insulin or making dosing easier. Additional research
is needed to support the use of carbohydrate counting in
clinical practice, particularly in children and adolescents.
Recent studies examining the effect of protein and fat on
insulin requirements show promising results and could
provide an alternative method for determining prandial
insulin dose.
Lifestyle Intervention Is Beneficial
in Pregnant Women at Risk for
Gestational Diabetes
physical activity. Women in the RC group received written
literature on physical activity and diet during pregnancy
during their baseline visit only and proceeded with regular
prenatal care as scheduled.
Study
outcomes
included
physical
activity
determined by a self-reported Pregnancy Physical Activity
Questionnaire, gestational weight gain from baseline visit,
glucose metabolism (total glucose area under the curve),
documented evidence of gestational diabetes, and insulin
resistance (homeostatic model of insulin resistance). There
were no differences in baseline characteristics between
the two groups. Subjects were mean age 24 years and ~12
weeks pregnant when recruited. About 60% of the total
sample was either obese or morbidly obese and >30% were
current or former smokers. The majority of women reported
diabetes in a first-degree relative.
Over the duration of their pregnancies, women in
the LSI group gained ~10 kg versus 9 kg for women in the
RC group. There were no differences between groups in
the median weight gained at midpregnancy and prior to
delivery, or in the amount of weight retained from delivery
to the 6-week postpartum visit.
Women in the LSI group had higher odds of meeting
physical activity recommendations at midpregnancy
compared with women in the RC group (OR, 1.60; 95% CI,
0.49 to 5.38; Figure 1).
Figure 1. Percentage of Subjects Meeting Physical
Activity Recommendations
Regular/standard care
80
Written by Maria Vinall
70
∆=13.1%
∆=7.2%
60
Subjects (%)
Lifestyle modifications incorporating healthy diet and
increased physical activity in nonpregnant adults are effective
for proper weight control as well as prevention of diabetes
in at-risk individuals. Jessica Marcinkevage, PhD, MSPH,
Centers for Disease Control and Prevention and Emory
University, Atlanta, Georgia, USA, reported the results of study
in pregnant women at risk for gestational diabetes in which a
similar lifestyle intervention (LSI) was effective in improving
glucose metabolism and insulin resistance.
The objective of this randomized, controlled, pilot
feasibility study was to assess the effects of LSI on glucose
metabolism and insulin resistance in overweight/obese
(body mass index [BMI] ≥25 kg/m2) low-income African
American women. Women <20 weeks gestation with
singleton pregnancies were randomized to either regular/
standard care (RC; n=29) or LSI (n=28) which included
individualized one-on-one counseling on physical activity
and dietary advice in addition to standard care. They also
received biweekly booster calls and pedometers to track
p for ∆=0.4
OR, 1.60
95% CI, 0.49 to 5.38
Lifestyle intervention
50
40
30
20
10
0
Baseline
Midpregnancy
Reproduced with permission from J Marcinkevage, PhD, MSPH.
There was improved glucose metabolism (p<0.05) at
midpregnancy in the LSI group. There were trends indicating
improved insulin resistance at both midpregnancy and
post partum for the LSI group compared with the RC group.
(Figure 2). In addition, for women in the LSI group there
was a 12% decrease in the odds of developing gestational
diabetes compared with those in the RC group (Figure 3).
Official Peer-Reviewed Highlights From the American Diabetes Association 73rd Scientific Sessions 2013
9
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