孕期糖尿病的檢診監測與藥物選擇

Diagnosis, Monitoring and Pharmacological Options for Diabetes Mellitus in Pregnancy

林治平(Chih-Ping Lin) ； 呂介華(Chieh-Hua Lu)

《內科學誌》 35卷5期 (2024/10) Pp. 348-357

https://doi.org/10.6314/JIMT.202410_35(5).03

摘要

這篇文章基於2023年中華民國糖尿病學會發布的「孕期糖尿病臨床照護指引」第一、二章所建議之「藥物治療」，並引用了2024年美國糖尿病學會發布的糖尿病標準化醫療照護指南第十五章「孕期糖尿病的標準照護」中的一部分內容。我國生產的平均年齡逐年遞增，孕期糖尿病的盛行率亦隨之升高，孕期過高的血糖對孕婦、胎兒或是新生兒都會增加疾病風險。本文將基於孕期糖尿病的分類，重點回顧其定義、診斷方法、血糖監測方式以及降血糖藥物的臨床選擇和建議，旨在協助內科和產科醫師更好地跨科合作，並有效地管理和照護孕期糖尿病患者。

關鍵字

孕期糖尿病（diabetes mellitus in pregnancy, DIP） ； 孕前已知糖尿病（preexisting diabetes mellitus, PDM） ； 孕期中新診斷糖尿病（newly diagnosed diabetes mellitus） ； 妊娠糖尿病（gestational diabetes mellitus, GDM） ； 口服葡萄糖耐受試驗（oral glucose tolerance test, OGTT） ； 口服降血糖藥物（oral antihyperglycemic drugs, OADs）

並列摘要

This article is based on the recommendations for pharmacologic therapy of hyperglycemia in chapters 1 and 2 of the "Clinical Practice Guidelines for Diabetes Mellitus in Pregnancy 2023" published by the Diabetes Association of the Republic of China (DAROC) in 2023, and quotes part of chapter 15, "Management of Diabetes in Pregnancy" of the "Standards of Care in Diabetes-2024" published by the American Diabetes Association (ADA) in 2024. The prevalence of diabetes during pregnancy is increasing as the average age of birth in Taiwan increases each year. High blood glucose levels during pregnancy increase the risk of disease for the pregnant indivisual, the fetus and the newborn. Based on the classification of diabetes mellitus in pregnancy, this article will focus on reviewing its definition, diagnostic methods, blood glucose monitoring modalities, as well as clinical options and recommendations for hypoglycemic medications, with the aim of helping physicians and obstetricians to better collaborate interprofessionally and effectively manage and care for patients with diabetes mellitus in pregnancy.