Can a Dietary Supplement Prevent Gestational Diabetes Mellitus?

• Autores: Donald Coustan
• Localización: Diabetes care, ISSN-e 0149-5992, Vol. 36, Nº. 4, 2013, págs. 777-779
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Gestational diabetes mellitus (GDM), glucose intolerance with onset or first recognition during pregnancy, has been increasing (1) and will increase further with widespread adoption of new diagnostic criteria recommended by the American Diabetes Association (ADA) (2). GDM, even at the milder end of the diagnostic spectrum, is associated with fetal macrosomia, neonatal adiposity, preeclampsia, and cesarean section (3), which can be reduced by diagnosis and treatment (4,5). Such treatment is not without cost (6), and an effective, relatively simple, inexpensive approach to prevention could result in significant savings to the health care system, not to mention decreasing morbidity. In this issue of Diabetes Care, D�Anna et al. (7) describe a randomized controlled trial (RCT) of such a potential prevention strategy.

    Insulin resistance is characteristic of human pregnancy and may have evolved to ensure the fetus a continued supply of nutrients even in times of famine. Most gravidas increase insulin release and maintain euglycemia, while those with GDM are unable to do so adequately. While metformin, an insulin-sensitizing drug, initially appeared to prevent GDM in nonrandomized cohort studies, a double-blind RCT did not demonstrate efficacy (8). Inositol, present in many foods, is a component of inositolphosphoglycans, a second messenger for insulin action (9) (Fig. 1), and two of its nine isoforms, myo-inositol and chiro-inositol, have been used as insulin-sensitizing agents to treat insulin-resistant states such as polycystic ovary syndrome (PCOS) in doses ranging from 200 mg/day to 4 g/day (10�12). The authors of the current study have also demonstrated in an RCT a beneficial effect of myo-inositol in treating the metabolic syndrome in postmenopausal women (13). These same authors (14) reported a lower incidence of GDM (17 vs. 54%) among �