PracticeUpdate: Diabetes

CONFERENCE COVERAGE 24

Testing for Gestational Diabetes Mellitus Early in Pregnancy Is Necessary Most women increased insulin secretion sufficiently to prevent

development of gestational diabetes By the PracticeUpdate Editorial Team

G lucose tolerance improves on average, rather than deteriorates, during gestation in pregnant women with a body mass index (BMI) ≥ 25 kg/m 2 who are otherwise healthy, according to new research findings presented at ADA 2018. Testing for gestational diabetes mellitus (GDM) early in pregnancy is needed to understand pregnancy effects on glycemia and the clinical implications of earlier detection of GDM, the researchers concluded in their abstract. Although testing for diabetes in pregnancy is widely recommended, there is a lack of consensus on how to test and when during pregnancy to start testing, Wil- liam Knowler, MD, DrPH, with the National Institute of Diabetes and Digestive and Kidney Diseases in Phoe- nix, Arizona, told Elsevier’s PracticeUpdate . “In the LIFE-Moms randomized clinical trial of lifestyle inter- ventions designed to limit excess gestational weight loss, we found that despite the intervention lowering the numbers of women exceeding guidelines for preg- nancy weight gain, it had no effect on the presence of gestational diabetes when tested at 24 to 31 weeks gestational age.” 1 The ADA recommends that testing for GDM should start between 24–28 weeks’ gestation. This recommendation is based on the assumption that glucose tolerance worsens during pregnancy and, therefore, testing earlier in pregnancy will miss many cases that develop only later. It was this assumption that was being evaluated in LIFE-Moms, a consortium of randomized clinical trials of lifestyle interventions aimed at limiting gestational weight gain compared with standard care in 1,150 pregnant women with BMI

Dr. William Knowler

≥ 25 kg/m 2 recruited from different racial and ethnic groups in the United States. Previously reported findings noted that although lifestyle interventions modestly reduced excessive gestational weight gain (the primary outcome), they had no significant effect on the prevalence of GDM at 24–31 weeks. This study focused on the results of 75 g 2-hour oral glucose tolerance tests performed sequentially during pregnancy in a subset of 296 women tested at < 16 weeks (mean 12.6 weeks) gesta- tion and again at 24–31 weeks. Tests were interpreted according to the International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria.

Enteroendocrine Function of the Intestine By Jason Sloane MD W e were introduced to a relatively new concept in this lecture series about the fact that the intestine is the largest and one of the most important endocrine sys-

protein synthesis but also can increase the exocrine pancreas secretions. There is also increased intestinal cell prolifera- tion regulated by GLP-1. Perhaps most interestingly, GLP-1 has recently been found to attenuate the inflammatory response in the distal intestine to certain types of bacteria. It is important for clinicians to understand that GLP-1 agonists have actions beyond what they are prescribed for, and this may affect who these medications are prescribed for in the future and may even broaden their indications. www.practiceupdate.com/c/70309 

tems in the human body. We now know that most endocrine cells in the intestine have pluri-hormonal complexity and there are many hormones secreted by these cells aside from GLP-1 and GIP. In addition, we now understand that GLP-1 has many mechanisms of action which go beyond glucose control, which regulate appetite, obesity, and even the immune system. L cells are located in the distal intestine and can secrete GLP-1. We know through experiments that GLP-1 agonists increase local

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