A recent Communications Medicine study has conducted two systematic reviews to determine precision markers to predict effective lifestyle and pharmacological interventions to manage Gestational Diabetes Mellitus (GDM).
Study: Precision gestational diabetes treatment: a systematic review and meta-analyses. Image Credit: Photoroyalty/Shutterstock.com
Background
GDM is a common pregnancy complication that poses short- and long-term risks to the mother and the child. Research has shown that effective treatment of GDM can reduce serious perinatal morbidity.
Despite the existing heterogeneity, the current treatment assumes homogeneous requirements. These include regular home blood glucose monitoring, diet and lifestyle advice, clinic reviews, and pharmacological treatment with glyburide and/or insulin.
Many women need pharmacological treatment and cannot maintain euglycemia solely with lifestyle measures.
Prior research has documented that the need for insulin treatment in GDM is higher if the body mass index (BMI) is greater than 30 kg/m2, a prior history of GDM, or a family history of type 2 diabetes is present.
Current research has highlighted that precision biomarkers can predict potential treatment responses in type 2 diabetes (T2D). It must be noted that T2D has a heterogeneity similar to GDM; therefore, precision biomarkers could also predict treatment responses on GDM.
About this study
The present study contains two systematic literature reviews on precision markers of GDM treatment. Identifying individual characteristics that could be precision markers to predict responses to tailored lifestyle and diet interventions was a key aim of the review. Additionally, which precision biomarkers predicted the need to escalate treatment was studied.
The precision markers predicting neonatal and maternal outcomes and achieving glucose targets were considered. Using relevant keywords, the MEDLINE and EMBASE databases were searched from inception until the 1st of January, 2022. Studies published in English and including women over 16 were included.
The first review included studies with behavioral interventions (e.g., dietary interventions), while the second included those that studied GDM patients who required escalated pharmacological therapy (e.g., insulin).
Key findings
Few studies have examined the efficacy of lifestyle-based interventions in treating GDM patients, which highlights the need for additional research in this area.
On the contrary, many precision markers were found to identify women who might need escalated pharmacological treatment (e.g., BMI). In GDM, starting treatment early to reduce excess fetal growth is important.
Further, basing treatment on precision markers could prevent the over-medicalization of patients who could achieve their glucose targets with lifestyle interventions alone.
In the first systematic review, two studies were identified in which precision markers were analyzed as a secondary object of the trials.
Further, only two precision markers were studied, namely, communication of gestational weight gain (GWG) goals in accordance with pre-pregnancy BMI and early GWG to predict the efficacy of technological supplementation to behavioral interventions. Therefore, it was impossible to pinpoint precise markers in lifestyle-based interventions in GDM patients.
The second review identified many more precision markers of effective GDM treatment without pharmacological therapy. However, it must be noted that the sample sizes in most of the studies were quite low, and the data on the escalation to insulin was over a decade old.
Further, diagnostic differences and differences in clinical practices across regions could limit the generalizability of the findings.
Conclusions
A key limitation of the present study is that the reviews were solely based on secondary analyses from observational studies. In these studies, the primary aim was not to identify precision markers in GDM treatment.
Further, most data lacked details, such as the timing of BMI measurement and whether the measurement was taken by a clinician or self-reported.
Most of the studies were based in high-income countries and, therefore, may not be applicable in the context of low- and middle-income countries owing to marked differences in clinical practices.
Among the strengths of the study, the use of robust methods to identify an array of precision markers must be noted. Many of these markers can be easily translated into prediction models because they are routinely measured. To reduce bias, studies were excluded where the clinician chose the drug based on participant characteristics.
In sum, the findings here suggest that precision medicine for GDM treatment could effectively identify the best treatment for patients and provide cost-effective care. This is an active area of research, and more work should be done to identify more sensitive markers.
Additionally, research should also consider how precision markers could be implemented cost-effectively in clinical practice. This will be important to design care and optimize short- and long-term health outcomes for mothers and their children.
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