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Issue 216 Item 4 Asymptomatic Hypoglycemia Is Common in Gestational Diabetes

Women with gestational diabetes are vulnerable to frequent episodes of asymptomatic hypoglycemia. Dr. Yariv Yogev of St. Luke’s-Roosevelt Hospital Center, New York, and colleagues there and elsewhere studied 82 women with gestational diabetes who were followed with a continuous glucose monitoring system for 72 hours. Thirty of the women were being treated with insulin, 25 were taking glyburide, and 27 were being managed only with a diabetic diet. For each patient, the glucose monitoring system provided more than 750 glucose measurements during the 72-hour monitoring period.
In their diabetic subjects and in 35 nondiabetic pregnant women who served as controls, the researchers sought to identify asymptomatic hypoglycemic episodes, which they defined as more than 30 consecutive minutes during which glucose levels were below 50 mg/dL with the patient unaware of the hypoglycemia.

Nineteen insulin-treated patients, or 63%, and 7 glyburide-treated women, or 28%, had asymptomatic hypoglycemic episodes, according to the authors. There were no such episodes in diet-only patients or in control subjects.

The insulin-treated patients had an average of 4.2 episodes each day, most during the night. The glyburide-treated patients had an average of 2.1 episodes per day, equally distributed during the day and night.

"Our data suggest that asymptomatic hypoglycemic events are common during pharmacological treatment in gestational diabetic pregnancies," the researchers write. The finding, they add, "may be explained by treatment modality, rather than by the disease itself."

"The question remains, what is the clinical implication of short-time maternal hypoglycemic events for both maternal and fetal well-being in diabetic pregnancies? There is a scarcity of data concerning this question," the authors write. Obstet Gynecol 2004;104:88-93.

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