Baas, M.G. (2014) Do all patients with gestation diabetes mellitus need to be treated in hospitals? A comparison study between patients treated with and without adjuvant insulin therapy. thesis, Medicine.
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Abstract
Background and Aim Gestational Diabetes Mellitus(GDM) is a condition in which patients suffer from impaired glucose tolerance first recognized during pregnancy which causes complications for both mother and child. Intervention studies have shown that treatment of GDM improves pregnancy outcomes and current guidelines suggest that this treatment should take place in the hospital. However, the implementation of the current guidelines have caused a rise in the number of GDM patients who are referred to these hospitals causing capacity problems. When it is possible to refer a ‘low risk group’ back to their own midwife this would provide an essential solution to the increasing capacity problems. The primary aim of this research is to assess the possibility to refer patients who do not require insulin therapy back to their own midwife outside the hospital. Methods In this retrospective cohort study patients were included who were treated following current guidelines for GDM between January 2011 and July 2014. Data from the Martini Hospital and the UMCG was acquired via digital and paper patient records. A total of 789 pregnancies were eligible for evaluation. A comparison in pregnancy outcomes between patients treated with dietary adaptations only and those in need for additional insulin treatment was made. Pregnancy outcomes included fetal complications (death, birth trauma and admission) and maternal complications (hypertensive complications and secondary caesarean sections). Results Apart from a difference in induction strategy of labour in GDM patients, no major differences were found in pregnancy outcomes between both hospitals. Prior to gestation patients in the diet group had significantly less risk factors to adverse outcomes compared to patients treated with adjuvant insulin therapy; they were younger, had less overweight and less risk factors to GDM. Additionally this group showed lower glucose levels throughout gestation compared to patients who did receive insulin therapy. However, both maternal and fetal perinatal complications did not show a significant difference between diet treated patients and insulin treated patients. Secondary outcomes such as birth weight and APGAR scores even showed an unfavourable trend in the diet-only group compared to insulin-treatment group. Conclusion The results of this study suggest that GDM patients who do not require insulin treatment according to current guidelines do not have better pregnancy outcomes than those who are treated with insulin therapy. There is even a tendency towards more adverse pregnancy outcomes in the diet-only group. Therefore the group of patients who do not require insulin treatment cannot be considered as a ‘low risk group’ to be safely referred back to their own midwife for supervision of their pregnancy and labour.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Hoogenberg, Dr. K. and Martiniziekenhuis Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:52 |
| Last Modified: | 25 Jun 2020 10:52 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1298 |
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