Glyburide, exercise moderate gestational diabetes. (Pregnancy Studies Still Needed for Starlix).

STANFORD, CALIF. -- Diet and insulin are no longer the only tools available for the management of gestational diabetes mellitus, Dr. Judy E. Kalinyak said at a conference on perinatal and pediatric nutrition.

They've been joined by exercise and the second-generation oral sulfonylurea agent glyburide. And further down the line is the prospect of treating gestational diabetes with nateglinide (Starlix), an oral agent released last December that addresses the postprandial hypoglycemia lying at the heart of the problem, but for which no safety studies in pregnancy exist, explained Dr. Kalinyak, an endocrinologist at Stanford (Calif.) University.

Exercise is remarkably effective therapy in couch potatoes with gestational diabetes. When contracting, skeletal muscle increases its glucose uptake 35 times. Exercise also increases insulin sensitivity and reduces intracellular triglyceride levels, she said at the meeting, which was also jointly sponsored by Symposia Medicus and Stanford University

A few caveats regarding exercise: "We want minimal exertion because you end up with increased risk of genetic defects when basal body temperature climbs above 38[degrees]C--you get your heat shock proteins turned on at that point. But that takes at least 15-20 minutes or more of strenuous exercise.

There is also an increased injury risk inherent in encouraging exercise at a time of pregnancy-induced connective tissue laxity and joint instability in women with little exercise experience and a center of balance that shifts almost daily.

Glyburide was recently shown to achieve the same degree of glycemic control as insulin in a major randomized study involving 404 women with gestational diabetes. This comparison of glyburide and insulin therapy was conducted by Dr. Oded Langer and associates at St. Luke's-Roosevelt Hospital ...