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| 1 | Pathophysiological 角色和在糖尿病的 nephropathy 的发炎的治疗学的含意显示文摘 Diabetes mellitus and its complications are becoming one of the most important health problems in the world. Diabetic nephropathy is now the main cause of end-stage renal disease. The mechanisms leading tothe development and progression of renal injury are not well known. Therefore, it is very important to f ind new pathogenic pathways to provide opportunities for early diagnosis and targets for novel treatments. At the present time, we know that activation of innate immunity with development of a chronic low grade inflammatory response is a recognized factor in the pathogenesis of diabetic nephropathy. Numerous experimental and clinical studies have shown the participation of different inflammatory molecules and pathways in the pathophysiology of this complication. | Desirée Luis-Rodríguez Alberto Martínez-Castelao José Luis Górriz Fernando de lvaro Juan F Navarro-González | 2012 | World Journal of Diabetes2012，3，1： | 55 |
| 2 | Osteoporosis in diabetes mellitus: Possible cellular and molecular mechanisms显示文摘Osteoporosis,a global age-related health problem in both male and female elderly,insidiously deteriorates the microstructure of bone,particularly at trabecular sites,such as vertebrae,ribs and hips,culminating in fragility fractures,pain and disability.Although osteoporosis is normally associated with senescence and estrogen deficiency,diabetes mellitus(DM),especially type 1 DM,also contributes to and/or aggravates bone loss in osteoporotic patients.This topic highlight article focuses on DM-induced osteoporosis and DM/ osteoporosis comorbidity,covering alterations in bone metabolism as well as factors regulating bone growth under diabetic conditions including,insulin,insulin-like growth factor-1 and angiogenesis.Cellular and molecular mechanisms of DM-related bone loss are also discussed.This information provides a foundation for the better understanding of diabetic complications and for development of early screening and prevention of osteoporosis in diabetic patients. | Kannikar Wongdee Narattaphol Charoenphandhu | 2011 | World Journal of Diabetes2011，2，3： | 51 |
| 3 | 在心血管的疾病的先进 glycation 结束产品的角色显示文摘 Advanced glycation end products(AGEs) are produced through the non enzymatic glycation and oxidation of proteins,lipids and nucleic acids.Enhanced formation of AGEs occurs particularly in conditions associated with hyperglycaemia such as diabetes mellitus(DM).AGEs are believed to have a key role in the development and progression of cardiovascular disease in patients with DM through the modif ication of the structure,function and mechanical properties of tissues through crosslinking intracellular as well as extracellular matrix proteins and through modulating cellular processes through binding to cell surface receptors [receptor for AGEs(RAGE)].A number of studies have shown a correlation between serum AGE levels and the development and severity of heart failure(HF).Moreover,some studies have suggested that therapies targeted against AGEs may have therapeutic potential in patients with HF.The purpose of this review is to discuss the role of AGEs in cardiovascular disease and in particular in heart failure,focussing on both cellular mechanisms of action as well as highlighting how targeting AGEs may represent a novel therapeutic strategy in the treatment of HF. | Zeinab Hegab Stephen Gibbons Ludwig Neyses Mamas A Mamas | 2012 | World Journal of Cardiology2012，4，4： | 58 |
| 4 | 西格列汀联合二甲双胍治疗2型糖尿病的疗效及对胰岛功能的影响显示文摘目的 探讨西格列汀和二甲双胍单药及联合治疗对2型糖尿病(T2DM)的疗效及对胰岛功能的影响.方法 将2011年1月至2012年12月收治的60例初治T2DM患者,按随机数字表法分为3组,西格列汀治疗组(S组,西格列汀100 mg每天1次)、二甲双胍治疗组(M组,二甲双胍500 mg每天3次)及西格列汀、二甲双胍联合治疗组(SM组,西格列汀100 mg每天1次+二甲双胍500 mg每天3次),每组20例.治疗12周后,比较三组治疗前后空腹血糖(FBG)、餐后2h血糖(2 hPG)、糖化血红蛋白(HbA1c)、血压、血脂及稳态模型β细胞功能指数(HOMA-β)、稳态模型胰岛素抵抗指数(HOMA-IR)等指标的变化,并观察体质指数(BMI)、药物不良反应发生况.治疗前后比较采用配对t检验,组间比较采用方差分析.结果 治疗后,三组血糖、HbA1c、血甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、血压及HOMA-IR均较治疗前明显下降,而HOMA-β均明显升高,差异均有统计学意义(均P <0.05).治疗后,S组与M组各项指标差异均无统计学意义(均P<0.05).SM组HbA1c(6.1%±0.5%)相较于S组(6.6%±0.5%)及M组(6.5%±0.6%)下降更为显著(F=4.964,P<0.05),血糖、TG、TC、LDL-C及血压亦显著下降(均P<0.05).与S组(65±18)及M组(63±23)相比,SM组HOMA-β(83±27)显著升高(F=4.349,P<0.05).治疗后三组HOMA-IR差异无统计学意义(F=0.149,P>0.05).S组治疗前后BMI无显著变化,M组及SM组治疗后BMI较前显著下降(均P<0.05),与S组比较差异均有统计学意义(均P<0.05).三组均未出现严重低血糖事件.结论 西格列汀起始单药治疗2型糖尿病对血糖的控制及胰岛β细胞功能的改善与二甲双胍相似,而两者联合用药效果更佳,且耐受性良好. | 王秀艳 潘天荣 钟兴 杜益君 高雅 章秋 | 2014 | 中华糖尿病杂志2014，6，6： | 51 |
| 5 | Literature review on the management of diabetic foot ulcer显示文摘Diabetic foot ulcer(DFU) is the most costly and devastating complication of diabetes mellitus, which affect 15% of diabetic patients during their lifetime.Based on National Institute for Health and Clinical Excellence strategies, early effective management of DFU can reduce the severity of complications such as preventable amputations and possible mortality, and also can improve overall quality of life. The management of DFU should be optimized by using a multidisciplinary team, due to a holistic approach to wound management is required. Based on studies, blood sugar control, wound debridement, advanced dressings and offloading modalities should always be a part of DFU management. Furthermore, surgery to heal chronic ulcer and prevent recurrence should be considered as an essential component of management in some cases. Also, hyperbaric oxygen therapy, electrical stimulation, negative pressure wound therapy, bio-engineered skin and growth factors could be used as adjunct therapies for rapid healing of DFU. So, it's suggested that with appropriate patient education encourages them to regular foot care in order to prevent DFU and its complications. | Leila Yazdanpanah Morteza Nasiri Sara Adarvishi | 2015 | World Journal of Diabetes2015，6，1： | 55 |
| 6 | Diabetes mellitus: The epidemic of the century显示文摘The epidemic nature of diabetes mellitus in different regions is reviewed. The Middle East and North Africa region has the highest prevalence of diabetes in adults(10.9%) whereas, the Western Pacific region has the highest number of adults diagnosed with diabetes and has countries with the highest prevalence of diabetes(37.5%). Different classes of diabetes mellitus, type 1, type 2, gestational diabetes and other types of diabetes mellitus are compared in terms of diagnostic criteria, etiology and genetics. The molecular genetics of diabetes received extensive attention in recent years by many prominent investigators and research groups in the biomedical field. A large array of mutations and single nucleotide polymorphisms in genes that play a role in the various steps and pathways involved in glucose metabolism and the development, control and function of pancreatic cells at various levels are reviewed. The major advances in the molecular understanding of diabetes in relation to the different types of diabetes in comparison to the previous understanding in this field are briefly reviewed here. Despite the accumulation of extensive data at the molecular and cellular levels, the mechanism of diabetes development and complications are still not fully understood. Definitely, more extensive research is needed in this field that will eventually reflect on the ultimate objective to improve diagnoses, therapy and minimize the chance of chronic complications development. | Akram T Kharroubi Hisham M Darwish | 2015 | World Journal of Diabetes2015，6，6： | 53 |
| 7 | Biomolecular basis of the role of diabetes mellitus in osteoporosis and bone fractures显示文摘Osteoporosis has become a serious health problem throughout the world which is associated with an increased risk of bone fractures and mortality among the people of middle to old ages.Diabetes is also a major health problem among the people of all age ranges and the sufferers due to this abnormality increasing day by day.The aim of this review is to summarize the possible mechanisms through which diabetes may induce osteoporosis.Diabetes mellitus generally exerts its effect on different parts of the body including bone cells specially the osteoblast and osteoclast,muscles,retina of the eyes,adipose tissue,endocrine system specially parathyroid hormone(PTH) and estrogen,cytokines,nervous system and digestive system.Diabetes negatively regulates osteoblast differentiation and function while positively regulates osteoclast differentiation and function through the regulation of different intermediate factors and thereby decreases bone formation while increases bone resorption.Some factors such as diabetic neuropathy,reactive oxygen species,Vitamin D,PTH have their effects on muscle cells.Diabetes decreases the muscle strength through regulating these factors in various ways and ultimately increases the risk of fall that may cause bone fractures. | Bipradas Roy | 2013 | World Journal of Diabetes2013，4，4： | 41 |
| 8 | Cardiac autonomic neuropathy in patients with diabetes mellitus显示文摘Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death.In addition,autoimmune and genetic factors are involved in the development of CAN.CAN might be subclinical for several years until the patient develops resting tachycardia,exercise intolerance,postural hypotension,cardiac dysfunction and diabetic cardiomyopathy.During its sub-clinical phase,heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic.Newer imaging techniques(such as scintigraphy)have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system.One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN;however,the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN,and also proposed screening for CAN in patients with diabetes mellitus.A major challenge,however,is the lack of specific treatment to slow the progression or prevent the development of CAN.Lifestyle changes,improved metabolic control might prevent or slow the progression of CAN.Reversal will require combination of these treatments with new targeted therapeutic approaches.The aim of this article is to review the latest evidence regarding the epidemiology,pathogenesis,manifestations,diagnosis and treatment for CAN. | Gerasimos Dimitropoulos Abd A Tahrani Martin J Stevens | 2014 | World Journal of Diabetes2014，5，1： | 48 |
| 9 | Metabolic syndrome and non-alcoholic fatty liver disease:Asian definitions and Asian studies显示文摘BACKGROUND: Non-alcoholic fatty liver disease (NAFLD), as conventionally recognized, is a metabolic disorder largely confined to residents of affluent industrialized Western countries. However, obesity and insulin resistance are not restricted to the West, as witnessed by their increasingly universal distribution. In particular, there has been an upsurge in metabolic syndrome in the Asia-Pacific region, although there are critical differences in the extent of adiposity between Eastern and Western populations. DATA SOURCES: An English-language literature search using PubMed (1999-2007) on obesity, metabolic syndrome and NAFLD, focusing on Asian definitions and Asian studies. RESULTS: NAFLD appears to be of long-standing insulin resistance and likely represents the hepatic manifestation of the metabolic syndrome. With insulin resistance as a common factor, the disease is associated with atherosclerosis and cardiovascular risk. All features of the metabolic syndrome and related events are assessed for practical management of NAFLD, although the criteria for the diagnosis of obesity and central obesity differ across racial groups. CONCLUSIONS: The increasing prevalence of obesity, coupled with diabetes, dyslipidemia, hypertension and ultimately metabolic syndrome, puts a very large population at risk of developing NAFLD in the coming decades. The simultaneous identification and appropriate treatment of the components of metabolic syndrome are crucial to reduce hepatic as well as cardiovascular morbidity and mortality. | Fan, Jian-Gao Peng, Yong-De | 2007 | Hepatobiliary & Pancreatic Diseases International2007，6，6： | 42 |
| 10 | Targeting inflammation in diabetes: Newer therapeutic options显示文摘Inflammation has been recognised to both decrease beta cell insulin secretion and increase insulin resis-tance. Circulating cytokines can affect beta cell function directly leading to secretory dysfunction and increased apoptosis. These cytokines can also indirectly affect beta cell function by increasing adipocyte inflamma-tion.The resulting glucotoxicity and lipotoxicity further enhance the inflammatory process resulting in a vicious cycle. Weight reduction and drugs such as metformin have been shown to decrease the levels of C-Reactive Protein by 31% and 13%, respectively. Pioglitazone, insulin and statins have anti-inflammatory effects. In-terleukin 1 and tumor necrosis factor-α antagonists are in trials and NSAIDs such as salsalate have shown an improvement in insulin sensitivity. Inhibition of 12-lipo-oxygenase, histone de-acetylases, and activation of sirtuin-1 are upcoming molecular targets to reduce in-flammation. These therapies have also been shown to decrease the conversion of pre-diabetes state to diabe-tes. Drugs like glicazide, troglitazone, N-acetylcysteine and selective COX-2 inhibitors have shown benefit in diabetic neuropathy by decreasing inflammatory mark-ers. Retinopathy drugs are used to target vascular en-dothelial growth factor, angiopoietin-2, various protein-ases and chemokines. Drugs targeting the proteinases and various chemokines are pentoxifylline, inhibitors of nuclear factor-kappa B and mammalian target of rapa-mycin and are in clinical trials for diabetic nephropathy. Commonly used drugs such as insulin, metformin, per-oxisome proliferator-activated receptors, glucagon like peptide-1 agonists and dipeptidyl peptidase-4 inhibitors also decrease inflammation. Anti-inflammatory thera-pies represent a potential approach for the therapy of diabetes and its complications. | Neeraj Kumar Agrawal Saket Kant | 2014 | World Journal of Diabetes2014，5，5： | 41 |
| 11 | 2型糖尿病合并高血压患者空腹血糖控制相关因素研究显示文摘目的 了解无锡城乡社区2型糖尿病合并高血压患者临床指标特征,分析影响其血糖控制的因素.方法 采取分层整群抽样方法,分别在无锡市城市和农村中各抽取2个社区,对登记管理的927例2型糖尿病患者,开展问卷调查、体格检查和血生化检查,比较糖尿病血压正常组和糖尿病合并高血压组的相关信息和临床指标,以空腹血糖控制是否达标为应变量,进行Logistic回归分析影响血糖控制的因素.结果 2型糖尿病合并高血压组总并发症、大血管并发症和血脂异常患病比例分别为28.51%、21.00%和53.27%,均高于糖尿病血压正常组(分别为10.90%、5.45%和44.08%),差异均有统计学意义(均有P<0.05);2型糖尿病合并高血压组血清尿酸、血清肌酐和体质指数均值均高于糖尿病血压正常组,差异均有统计学意义(均有P <0.05).多因素Logistic回归分析显示,城市地区利于糖尿病合并高血压患者血糖控制(与农村地区相比,OR=0.50,95% CI:0.27~0.93),而糖尿病病程长(OR=1.66,95% CI:1.18 ~2.34)、血压高(OR=1.51,95% CI:1.16~1.96)不利血糖控制.结论 城乡社区2型糖尿病合并高血压患者的状况不容乐观,农村尤为严重,社区糖尿病患者管理需探索有效的适宜技术. | 董美华 钱云 陈再芳 沈洪兵 | 2014 | 中华疾病控制杂志2014，18，1： | 44 |
| 12 | 医院-社区-家庭延续护理模式对2型糖尿病患者血糖和饮食控制效果的影响显示文摘目的 探讨医院-社区-家庭三位一体的延续护理模式对2型糖尿病患者血糖和饮食控制的效果.方法 采取方便抽样法选取2015年3月—2016年3月入住江苏省中医院内分泌科的2型糖尿病患者118例,借助随机数字表将入选患者分为对照组和研究组,每组纳入患者59例,对照组给予内分泌科专科护理及常规出院指导,研究组给予内分泌科专科护理及医院-社区-家庭延续护理出院指导,观察两组患者血糖和饮食控制的效果.结果 干预实施6个月后,研究组患者血糖控制水平优于对照组,差异有统计学意义(t=3.98,P〈0.05);研究组患者食物摄入达标情况优于对照组,差异有统计学意义(P〈0.05).结论 对2型糖尿病患者实施医院-社区-家庭延续护理,有利于患者控制血糖和改善饮食. | 李巧云 王宁玫 黄莹 张炎 | 2017 | 中华现代护理杂志2017，23，19： | 49 |
| 13 | Ocular complications of diabetes mellitus显示文摘Diabetes mellitus(DM) is a important health problem that induces ernestful complications and it causes significant morbidity owing to specific microvascular complications such as, retinopathy, nephropathy and neuropathy, and macrovascular complications such as, ischaemic heart disease, and peripheral vasculopathy. It can affect children, young people and adults and isbecoming more common. Ocular complications associated with DM are progressive and rapidly becoming the world's most significant cause of morbidity and are preventable with early detection and timely treatment. This review provides an overview of five main ocular complications associated with DM, diabetic retinopathy and papillopathy, cataract, glaucoma, and ocular surface diseases. | Nihat Sayin Necip Kara G?khan Pekel | 2015 | World Journal of Diabetes2015，6，1： | 38 |
| 14 | Type 2 diabetes mellitus:From a metabolic disorder to an inflammatory condition显示文摘Diabetes mellitus is increasing at an alarming rate and has become a global challenge.Insulin resistance intarget tissues and a relative deficiency of insulin secretion from pancreatic β-cells are the major features of type 2 diabetes(T2D).Chronic low-grade inflammation in T2 D has given an impetus to the field of immuno-metabolism linking inflammation to insulin resistance and β-cell dysfunction.Many factors advocate a causal link between metabolic stress and inflammation.Numerous cellular factors trigger inflammatory signalling cascades,and as a result T2 D is at the moment considered an inflammatory disorder triggered by disordered metabolism.Cellular mechanisms like activation of Tolllike receptors,Endoplasmic Reticulum stress,and inflammasome activation are related to the nutrient excess linking pathogenesis and progression of T2 D with inflammation.This paper aims to systematically review the metabolic profile and role of various inflammatory pathways in T2 D by capturing relevant evidence from various sources.The perspectives include suggestions for the development of therapies involving the shift from metabolic stress to homeostasis that would favour insulin sensitivity and survival of pancreatic β-cells in T2 D. | Iqra Hameed Shariq R Masoodi Shahnaz A Mir Mudasar Nabi Khalid Ghazanfar Bashir A Ganai | 2015 | World Journal of Diabetes2015，6，4： | 36 |
| 15 | Diabetic foot disease:From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities显示文摘The burden of diabetic foot disease(DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy(DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities. | Noha Amin John Doupis | 2016 | World Journal of Diabetes2016，7，7： | 39 |
| 16 | Update on the treatment of type 2 diabetes mellitus显示文摘To achieve good metabolic control in diabetes and keep long term, a combination of changes in lifestyle and pharmacological treatment is necessary. Achieving near-normal glycated hemoglobin significantly, decreases risk of macrovascular and microvascular complications. At present there are different treatments, both oral and injectable, available for the treatment of type 2 diabetes mellitus(T2DM). Treatment algorithms designed to reduce the development or progression of the complications of diabetes emphasizes the need for good glycaemic control. The aim of this review is to perform an update on the benefits and limitations of different drugs, both current and future, for the treatment of T2 DM. Initial intervention should focus on lifestyle changes. Moreover, changes in lifestyle have proven to be beneficial, but for many patients is a complication keep long term. Physicians should be familiar with the different types of existing drugs for the treatment of diabetes and select the most effective, safe and better tolerated by patients. Metformin remains the first choice of treatment for most patients. Other alternative or second-line treatment options should be individualized depending on the characteristics of each patient. This article reviews the treatments available for patients with T2 DM, with an emphasis on agents introduced within the last decade. | Juan Jose Marin-Penalver Iciar Martin-Timon Cristina Sevillano-Collantes Francisco Javier del Canizo-Gomez | 2016 | World Journal of Diabetes2016，7，17： | 37 |
| 17 | Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research显示文摘The incidence of diabetes mellitus(DM) continues to rise and has quickly become one of the most prevalent and costly chronic diseases worldwide. A close link exists between DM and cardiovascular disease(CVD), which is the most prevalent cause of morbidity and mortality in diabetic patients. Cardiovascular(CV) risk factors such as obesity, hypertension and dyslipidemia are common in patients with DM, placing them at increased risk for cardiac events. In addition, many studies have found biological mechanisms associated with DM that independently increase the risk of CVD in diabetic patients. Therefore, targeting CV risk factors in patients with DM is critical to minimize the long-term CV complications of the disease. This paper summarizes the relationship between diabetes and CVD, examines possible mechanisms of disease progression, discusses current treatment recommendations, and outlines future research directions. | Benjamin M Leon Thomas M Maddox | 2015 | World Journal of Diabetes2015，6，13： | 39 |
| 18 | WJD 5^(th) Anniversary Special Issues(2): Type 2 diabetes Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength?显示文摘Diabetes mellitus is a chronic condition that occurs when the body cannot produce enough or effectively use of insulin.Compared with individuals without diabetes,patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality,and are disproportionately affected by cardiovascular disease.Most of this excess risk is it associated with an augmented prevalence of well-known risk factors such as hypertension,dyslipidaemia and obesity in these patients.However the improved cardiovascular disease in type 2 diabetes mellitus patients can not be attributed solely to the higher prevalence of traditional risk factors.Therefore other non-traditional risk factors may be important in people with type 2 diabetes mellitus.Cardiovascular disease is increased in type 2 diabetes mellitus subjects due to a complex combination of various traditional and non-traditional risk factors that have an important role to play in the beginning and the evolution of atherosclerosis over its long natural history from endothelial function to clinical events.Many of these risk factors could be common history for both di-abetes mellitus and cardiovascular disease,reinforcing the postulate that both disorders come independently from'common soil'.The objective of this review is to highlight the weight of traditional and non-traditional risk factors for cardiovascular disease in the setting of type 2 diabetes mellitus and discuss their position in the pathogenesis of the excess cardiovascular disease mortality and morbidity in these patients. | Iciar Martín-Timón Cristina Sevillano-Collantes Amparo Segura-Galindo Francisco Javier del Caizo-Gómez | 2014 | World Journal of Diabetes2014，5，4： | 32 |
| 19 | Vascular endothelial dysfunction, cardiomyopathy a major mediator in diabetic cardiomyopathy显示文摘Diabetes mellitus is currently a major public health problem.A common complication of diabetes is cardiac dysfunction,which is recognized as a microvascular disease that leads to morbidity and mortality in diabetic patients.While ischemic events are commonly observed in diabetic patients,the risk for developing heart failure is also increased,independent of the severity of coronary artery disease and hypertension.This diabetes-associated clinical entity is considered a distinct disease process referred to as 'diabetic cardiomyopathy'.However,it is not clear how diabetes promotes cardiac dysfunction.Vascular endothelial dysfunction is thought to be one of the key risk factors.The impact of diabetes on the endothelium involves several alterations,including hyperglycemia,fatty acid oxidation,reduced nitric oxide (NO),oxidative stress,inflammatory activation,and altered barrier function. The current review provides an update on mechanisms that specifically target endothelial dysfunction,which may lead to diabetic cardiomyopathy. | Maura Knapp Xin Tu Rongxue Wu | 2019 | Acta Pharmacologica Sinica2019，40，1： | 34 |
| 20 | Changing trends in management of gestational diabetes mellitus显示文摘Gestational diabetes mellitus(GDM)is on the rise globally.In view of the increasing prevalence of GDM and fetal and neonatal complications associated with it,there is a splurge of research in this field and management of GDM is undergoing a sea change.Trends are changing in prevention,screening,diagnosis,treatment and future follow up.There is emerging evidence regarding use of moderate exercise,probiotics and vitamin D in the prevention of GDM.Regarding treatment,newer insulin analogs like aspart,lispro and detemir are associated with better glycemic control than older insulins.Continuous glucose monitoring systems and continuous subcutaneous insulin systems may play a role in those who require higher doses of insulin for sugar control.Evidence exists that favors metformin as a safer alternative to insulin in view of good glycemic control and better perinatal outcomes.As the risk of developing GDM in subsequent pregnancies and also the risk of overt diabetes in later life is high,regular assessment of these women is required in future.Lifestyle interventions or metformin should be offered to women with a history of GDM who develop pre-diabetes.Further studies are required in the field of prevention of GDM for optimizing obstetric outcome. | Gunasekaran Kala Poomalar | 2015 | World Journal of Diabetes2015，6，2： | 32 |
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