Diagnostik und Behandlung des Gestationsdiabetes entsprechend den aktuellsten Leitlinien

Zusammenfassung

Gestationsdiabetes (GDM) ist eine der häufigsten Schwangerschaftserkrankungen mit steigender Prävalenz – nicht zuletzt wegen der bedenklichen Zunahme von Adipositas unter jungen Frauen. GDM ist aber auch eine der Schwangerschaftskomplikationen, über die in den letzten Jahren am meisten diskutiert wurde – mit den größten Kontroversen insbesondere zur Frage der Diagnostik. Auch die Ansichten über die Intensität der Stoffwechselkontrolle, die Blutzuckerzielwerte und die Indikation zur Insulintherapie gingen weit auseinander, sehr zum Leidwesen der Behandler und der Schwangeren. Die letzten fünf Jahre erbrachten durch die Veröffentlichung bahnbrechender Studien einen großen Erkenntnisgewinn, der sich weltweit in neuen Empfehlungen zur Diagnostik und Therapie des GDM niederschlägt. So auch in Deutschland: eine interdisziplinäre Arbeitsgruppe der Diabetologen, Geburtmediziner und Neonatalogen hat in Anlehnung an diese internationalen Empfehlungen die seit 2001 gültigen Leitlinien überarbeitet. Der nachfolgende Artikel stellt die wichtigsten prakti schenAspekte für das diagnostische und therapeutische Vorgehen vor.

Summary

Gestational diabetes (GDM) is one of the most common disorders in pregnancy with increa -sing prevalence – partly due to the alarming increase of obesity in young women. However, GDM wasalso one pregnancy complication with the highest need for discussion in the last decade and there was a wide controversy particularly regarding the diagnostic procedure and criteria but as well regarding intensity of glucose control, glucose goal and when to start insulin therapy. A very difficult situation for care givers and patients. Finally, publications of epoch-making studies during the last five years provided data with high level of evidence and lead to new recommendations. These are going to be adopted worldwide to create uniform criteria for the diagnosis of GDM. Germany follows the line: an interdisciplinary expert team of diabetologists, perinatologists and neonatologists revised the German guidelines from 2001 according to the international proposal. The article presents the most relevant practical aspects regarding the recommended diagnostic and therapeutic procedure.

Schlüsselwörter

Gestationsdiabetes - Insulinresistenz in der Schwangerschaft - diagnostische Kriterien - Insulintherapie

Keywords

Gestational diabetes - insulin resistance in pregnancy - diagnostic procedure - insulin therapy

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