Prescribe diet, exercise after gestational diabetes. (Many Will Develop Type 2 Diabetes).

LITTLE ROCK, ARK. -- Diabetes prevention strategies should be initiated in all women who had gestational diabetes during pregnancy Dr. Sin Kjos said at the annual meeting of the North American Diabetes in Pregnancy Study Group.

About 70% of women diagnosed with gestational diabetes during pregnancy develop overt type 2 diabetes within 5 years. But data now suggest that this rate can be dramatically reduced with lifestyle modification and, in some cases, pharmaceutical intervention. At a minimum "all women who had gestational diabetes should be on diet and exercise," said Dr. Kjos of the University of Southern California, Los Angeles.

Janice Lazear, a diabetes nurse-educator at Johns Hopkins University, Baltimore, commented that she brings up the subject of future diabetes risk to all patients at the time they are diagnosed with gestational diabetes mellitus (GDM).

"I talk with women about the long-term complications of diabetes, especially heart disease. Sometimes we get so focused on neonatal outcome that we forget about the mother's health," she added.

Dr. Kjos recommended that blood glucose levels be regularly monitored in women with previous GDM. If they remain stable, diet and exercise regimens should be reinforced and maintained. Data suggest that if glucose levels begin to rise, adding an oral insulin-sensitizing agent can delay or prevent progression to diabetes, defined as a fasting blood glucose level greater than 125 mg/dL.

In the TRIPOD (Troglitazone in the Prevention of Diabetes) study, 266 Hispanic women who had a GDM pregnancy in the previous 4 years received either 400 mg/day of the insulin-sensitizing drug troglitazone or placebo. Follow-up was originally to be continued for 5 years, but the study was stopped early when troglitazone was removed from the market.

Still, even at 28-3 1 months' follow-up, the difference was dramatic: The 121 women on placebo developed diabetes at a rate of 12% per year, compared with just 5% among the 114 women who received troglitazone, for an overall reduction of 55% (Diabetes 51[9]:2796-803, 2002).