Turkiye Klinikleri Journal of Health Sciences

.: REVIEW
Gestasyonel Diabetes Mellitus ve Tıbbi Beslenme Tedavisi İlkeleri
Gestational Diabetes Mellitus and Principles of Medical Nutrition Therapy
Şaziye Ecem ÖRKÜa
aBeslenme ve Diyetetik Bölümü, Acıbadem Üniversitesi Sağlık Bilimleri Fakültesi, İstanbul, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2019;4(1):72-8
doi: 10.5336/healthsci.2018-60486
Article Language: TR
Full Text
ÖZET
 Gestasyonel diabetes mellitus (GDM); tanısı ilk kez gebelikte konulan, herhangi bir düzeydeki glukoz intoleransıdır. Görülme sıklığı çalışılan populasyona ve kullanılan tanı kriterine göre %1-14 arasında değişmektedir. Tedavisi, birçok komplikasyonun önlenmesi bakımından oldukça önemlidir. Tıbbi beslenme tedavisi (TBT) ise bu tedavinin olmazsa olmaz bir parçasıdır. TBT'de temel hedef ketoz gerçekleşmeden anne ve fetüsün gereksinimlerini karşılayarak optimal kan glukoz düzeylerinin sağlanmasıdır. Glukoz kontrolünü etkileyen en temel besin ögesi karbonhidrattır. Bu nedenle de karbonhidrat alımının düzenlenmesi glisemik kontrolün sağlanmasında hâlen en temel strateji gibi görünmektedir. Burada; karbonhidrat miktarı, türü ve dağılımı odaklanılması gereken konulardır. Tüm bunların yanı sıra TBT düzenlenirken, bireylerin gereksinimleri ve kişisel tercihleri de göz önünde bulundurulmalıdır. TBT, GDM'li bireylerin %30-90'ında birincil tedavi yöntemi olmakla birlikte, tedavi yöntemi ne olursa olsun her durumda tedavinin önemli bir parçasını oluşturmaktadır. Bu nedenle bu çalışmada, GDM ve TBT ilkeleri hakkında literatürden elde edilen veriler biraraya getirilerek, bu alanda çalışan bireylere güncel veri sunulması amaçlanmıştır.

Anahtar Kelimeler: Gebelik; diabetes mellitus; beslenme tedavisi
ABSTRACT
 Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that first recognized during pregnancy. Prevalence of GDM varies between 1-14% depending on the study population and diagnostic criteria. Treatment of GDM is important in terms of prevention of many complications. Medical nutrition therapy (MNT) is the cornerstone of the treatment. Main goal of MNT is to ensure optimal blood glucose levels while meeting maternal and fetal requirements without ketosis. Carbohydrate is the main macronutrient that affects glycemic control. Therefore, regulation of carbohydrate intake in the diet seems as the main strategy in regulation of glycemic control. In this situation, focusing on the type, quantity and distribution of carbohydrate throughout the day is essential. In addition, dietary requirements and personal preferences of pregnant women should be taken into consideration in planning of MNT. MNT is the primary therapy for 30-90% of women diagnosed with GDM and also regardless of the treatment method MNT constitutes an important part of treatment in all cases. Therefore, in this review it was aimed to present current data available in the literatüre on GDM and principles of MNT to the individuals working in this field.

Keywords: Pregnancy; diabetes mellitus; nutrition therapy
REFERENCES:
  1. American Diabetes Association (ADA). Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36(Suppl 1): S67-74. [Crossref][PubMed][PMC]
  2. American Diabetes Association. Standards of medical care in diabetes--2013. Diabetes Care. 2013;36 Suppl 1:S11-66. [Crossref][PubMed][PMC]
  3. Setji TL, Brown AJ, Feinglos MN. Gestational diabetes mellitus. Clinical Diabetes. 2005;23(1):17-22. [Crossref]
  4. Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007;30 (2):S251-60. [Crossref][PubMed]
  5. Singh SK, Rastogi A. Review: gestational diabetes mellitus. Diabetes & metabolic syndrome. Clinical Research & Reviews. 2008;2(3):227-34. [Crossref]
  6. Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25(10):1862-8. [Crossref][PubMed]
  7. Ben-Ziv RG, Hod M. Gestational diabetes mellitus. Fetal Matern Med Rev. 2008;19(3):245-69. [Crossref]
  8. American Diabetes Association. Standards of medical care in diabetes--2017. Diabetes Care. 2017;40(1):S1-135. [PubMed]
  9. Türkiye Endokrinoloji ve Metabolizma Derneği (TEMD). Diabetes Mellitus Çalışma ve Eğitim Grubu. Diabetes Mellitus ve Komplikasyonlarının Tanı, tedavi ve İzlem Kılavuzu-2013. 6. Baskı. Ankara: Miki Matbaacılık San ve Tic Ltd Şti; 2013. p.207.
  10. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352(24):77-86. [Crossref][PubMed]
  11. Reader DM. Medical nutrition therapy and lifestyle interventions. Diabetes Care. 2007;30 Suppl 2:S188-93. [Crossref][PubMed]
  12. American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2004;27(1): S88-90. [PubMed]
  13. Reader D, Splett P, Gunderson EP. Impact of gestational diabetes mellitus nutrition practice guidelines implemented by registered dietitians on pregnancy outcomes. J Am Diet Assoc. 2006;106(9):1426-33. [Crossref][PubMed]
  14. American Diabetes Association (ADA). Position statement: nutrition recommendations and interventions for diabetes. Diabetes Care. 2008;31(Suppl 1):S61-78. [Crossref][PubMed]
  15. IOM (Institute of Medicine) & NRC (National Research Council). Weight Gain During Pregnancy: Reexamining the Guidelines. 1st ed. Washington, DC: The National Academies Press; 2009. p.868.
  16. Coulston AM, Boushey CJ. Nutrition in the Prevention and Treatment of Disease. 2nd ed. China: Elsevier Academic Press; 2008. p.890.
  17. IOM (Institute of Medicine). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. 1st ed. Washington, DC: The National Academies Press; 2005. p.1358.
  18. American Diabetes Association (ADA). Franz MJ, Evert AB. American Diabetes Association Guide to Nutrition Therapy for Diabetes. 2nd ed. USA: American Diabetes Association; 2012. p.400.
  19. Academy of Nutrition and Dietetics. Gestational Diabetes Mellitus (GDM) Evidenced- Based Nutrition Practice Guidelines, 2008. <erişim 13.03.2018> [Link]
  20. Committee on Practice Bulletins--Obstetrics. Practice Bulletin No.137: gestational diabetes mellitus. Obstet Gynecol. 2013;122(2 Pt 1):406-16. [PubMed]
  21. Gilmartin AB, Ural SH, Repke JT. Gestational diabetes mellitus. Rev Obstet Gynecol. 2008;1(3):129-34. [PubMed]
  22. Reece EA, Hagay Z, Caseria D, Gay LJ, De- Gennaro N. Do fiber-enriched diabetic diets have glucose-lowering effects in pregnancy? Am J Perinatol. 1993;10(4):272-4. [Crossref] [PubMed]
  23. Procter SB, Campbell CG. Position of the Academy of Nutrition and Dietetics: nutrition and lifestyle for a healthy pregnancy outcome. J Acad Nutr Diet. 2014;114(7):1099-103. [Crossref][PubMed]
  24. Poel YH, Hummel P, Lips P, Stam F, van der Ploeg T, Simsek S. Vitamin D and gestational diabetes: a systematic review and meta-analysis. Eur J Intern Med. 2012;23(5):465-9. [Crossref][PubMed]
  25. Suhail M, Patil S, Khan S, Siddiqui S. Antioxidant vitamins and lipoperoxidation in non- pregnant, pregnant, and gestational diabetic women: erythrocytes osmotic fragility profiles. J Clin Med Res. 2010;2(6):266-73. [PubMed][PMC]

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