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Diabetes in Pregnancy Signals Future Trouble

But Diet, Exercise, and/or Drug Therapy Can Help Many Women Avoid It, Researchers Say
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WebMD Health News

June 7, 2004 (Orlando, Fla.) -- A new study shows that pregnant women who develop gestational diabetes can cut their risk of developing type 2 diabetes later in life in half with either a combination of diet and exercise, or with a drug commonly used to treat type 2 diabetes.

Women who develop this form of diabetes during pregnancy have a higher risk of developing type 2 diabetes after delivery and later in life.

"What I would say is that we need to be very aggressive with these patients," says Martin Abrahamson, MD, chief medical officer at the Joslin Diabetes Center in Boston. "I've always said that lifestyle modification is the way to go, but that being said, is it time for us to start thinking about the prevention of the disease with [drug] therapy, knowing that [drug] therapy is as effective as it is."

"Gestational diabetes, we know is a huge risk for the development of diabetes. What this is telling us is that gestational diabetes is probably a much bigger risk for developing diabetes than we previously thought," says Abrahamson.

A diabetes specialist who was not involved in the study tells WebMD that the study results should also be a warning flag for women who develop gestational diabetes.

Study researcher Robert E. Ratner, MD, from the MedStar Research Institute, tells WebMD that "if a woman has had a history of gestational diabetes, even after 10 years [after giving birth], her risk of developing diabetes itself is 70% higher than a comparable group of women without [gestational diabetes]."

The study was reported at the annual scientific meeting of the American Diabetes Association.

Future Risks Can Be Reduced

The study involved about 2,000 women -- 349 who had gestational diabetes in the past, 1,416 mothers who never had gestational diabetes, and 426 women who had never given birth.

The women received either instruction in intensive lifestyle changes, which included nutrition and exercise counseling, or medications -- either glucophage or a dummy pill. Glucophage was started at a dose of 850 milligrams daily. The average follow-up time during the study was almost three years. Neither the patients nor the researchers knew who was getting which pill.

The researchers showed that mothers who had had gestational diabetes cut their future risk of developing type 2 diabetes by more than half (54%) with glucophage or lifestyle changes.

Interestingly though, mothers who had never had gestational diabetes got much greater protection from diabetes by watching their diet and exercising than they did from taking glucophage, which helps the body use insulin more effectively.

Mothers who had never had gestational diabetes but exercised and dieted cut their risk of developing diabetes by half, yet glucophage reduced the risk of future type 2 diabetes by only 14%.

This was revealing to the researchers because other studies, done in people at high risk of developing diabetes in the future have shown that glucophage reduces the risk of type 2 diabetes by 31%, compared with a 58% reduction for diet and exercise.

The difference in how the women in the two groups -- the gestational diabetes group vs. the group without it -- responded to the drug show that gestational diabetes is an early warning sign of potentially serious problems down the road.

Ratner says the data from the study shows that women with gestational diabetes need to be followed by their doctors for signs of possible diabetes much longer than previously thought. "The risk persists, as far as we can tell, forever," he says.

SOURCE: 64th Annual Scientific Sessions American Diabetes Association, Orlando, Fla., June 4-8, 2004.

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