Precision gestational diabetes treatment: a systematic review and meta-analyses

Authors

Jamie L. Benham, Cumming School of Medicine
Véronique Gingras, University of Montreal
Niamh Maire McLennan, MRC Centre for Reproductive Health
Jasper Most, Zuyderland
Jennifer M. Yamamoto, University of Manitoba
Catherine E. Aiken, Rosie Hospital
Susan E. Ozanne, University of Cambridge
Susan E. Ozanne, University of Cambridge
Rebecca M. Reynolds, MRC Centre for Reproductive Health
Rebecca M. Reynolds, MRC Centre for Reproductive Health
Paul W. Franks, Harvard T.H. Chan School of Public Health
Stephen S. Rich, University of Virginia School of Medicine
Robert Wagner, Deutsches Diabetes-Zentrum
Tina Vilsbøll, Steno Diabetes Center Copenhagen
Kimberly K. Vesco, Kaiser Permanente Center for Health Research
Miriam S. Udler, Massachusetts General Hospital
Tiinamaija Tuomi, Helsinki University Hospital
Arianne Sweeting, Faculty of Medicine and Health
Emily K. Sims, Indiana University School of Medicine
Jennifer L. Sherr, Yale School of Medicine
Robert K. Semple, Edinburgh Medical School
Maria J. Redondo, Baylor College of Medicine
Leanne M. Redman, Pennington Biomedical Research Center
Richard E. Pratley, AdventHealth Translational Research Institute
Rodica Pop-Busui, University of Michigan Medical School
Toni I. Pollin, University of Maryland School of Medicine
Wei Perng, University of Colorado Anschutz Medical Campus
Ewan R. Pearson, University of Dundee School of Medicine
Katharine R. Owen, University of Oxford Medical Sciences Division
Richard Oram, University of Exeter Medical School
Rinki Murphy, Faculty of Medical and Health Sciences
Viswanathan Mohan, Madras Diabetes Research Foundation
Shivani Misra, Imperial College London
James B. Meigs, Harvard Medical School

Document Type

Article

Publication Date

12-1-2023

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.

This document is currently not available here.

Share

COinS