Lifestyle Modification and Pharmacological Therapy

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Background/Introduction:

GDM (gestational diabetes mellitus) is a disease that presents with carbohydrate intolerance and was initially discovered in pregnancy. In the majority of women, the postpartum glucose intolerance often gets back to normal levels, although there is a high risk of developing overt DM (diabetes mellitus) or impaired glucose tolerance later in life. Glycemic control has been achieved through various means including eating a balanced diet and taking medications such as insulin treatment.

Methods: This paper sought to establish through a PICO question the extent to which in pregnant females with GDM (P), lifestyle modification (I) compares with pharmacological therapy (C) to aid in the improvement of diabetic control and pregnancy outcomes (O). Therefore, search for the relevant articles was conducted in various online databases guided by this PICO question for secondary data.

Results: In most of articles reviewed, an examination of the PICO question showed that lifestyle modification, through such efforts as engaging in exercise and eating a balanced diet, is an efficacious way of managing GDM similar to pharmacological therapy.

Discussion: Lifestyle modification is an integral intervention to the prevention and control of patient outcomes when it comes to GDM.
Conclusion and Recommendation: Lifestyle modification and pharmacological therapy works in achieving glycemic control in GDM. Compared to pharmacological therapy, it would be more advisable for pregnant women to embrace lifestyle modification as the most preferred means of achieving glycemic or diabetic control for improved pregnancy outcomes.

Gestational diabetes mellitus (GDM) is a common complication of pregnancy with a reported prevalence of as high as sixteen percent, a rate that is on the rise across the globe (Wang et al., 2015). Maternal hyperglycemia has been established as causing a significantly high glucose transfer to the fetus, which occasions the overgrowth of the insulin-sensitive tissues and fetal hyperinsulinemia (Asemi, Samimi, Tabassi & Esmaillzadeh, 2014). The resultant excessive fetal growth causes shoulder dystopia, heightened trauma at birth, or even perinatal deaths. Obesity and being overweight before pregnancy presents a risk factor for GDM, enhancing the probability of adverse pregnancy outcome for mothers and babies (Wang et al., 2017).

Despite the fact that medical nutritional therapy (MNT) comes across an one of the cornerstone approaches to treating women with GDM, limited information exists as to the allowance of evidence-based recommendations concerning certain nutritional approaches that include control of fiber content or nutrient distribution in the management of GDM (Asemi, Samimi, Tabassi & Esmaillzadeh, 2014). Besides limited information on dietary approaches to the regulation of outcomes in women with GDM, other factors such as gestational weight issues need to be addressed more for improved GDM-related pregnancy outcomes.

Furthermore, even if regular exercise has been established as potentially reducing the risk of developing GDM, its efficacy still remains controversial (Wang et al., 2017). Medical nutrition therapy is also considered one of the mainstays of GDM treatment and management. Nevertheless, a limitation exists in data concerning the optimal diet that patients can use to attain glycemic control, as well as improved perinatal outcomes (Yamamoto et al., 2018).

According to obstetricians and medical experts, physical exercise and eating a balanced diet are deemed as some of the best lifestyle modification methods that play a significant role in the prevention and management of GDM (Wang et al., 2015). Maternal overweight and obesity issues are pertinent to the framing of this topic on GDM as major contributing factors.

These necessitate the conceptual model of BMI (body mass index) as one that determines the success of lifestyle modification (exercise and balanced diet) in improved GDM outcomes in pregnant women. It is prudent to note that a high BMI before or in the first trimester of pregnancy, as well as excessive GWG (gestational weight gain) in early and mid-pregnancy are deemed as early GDM markers that can be pharmacologically controlled or best managed through lifestyle modification.

Purpose Statement

In pregnant females with gestational diabetes mellitus (P), does lifestyle modification (I) in comparison with pharmacological therapy (C) help to improve diabetic control and pregnancy outcomes (O)?

Methods
Various academic databases were used in the retrieval of literature to be used in the paper. A comprehensive literature search was conducted through online biomedical databases, as well as specific literature resources. These databases included ProQuest, EBSOhost, Ovid, JSTOR, and MEDLINE/PubMed, which are search platforms recommended for systematic literature reviews in the healthcare professions by the United States National Library of Medicine (NLM). These large databases when combined with a general Internet search using Google Scholar created the opportunity of maximizing the number of relevant papers found in the search.

From the initial search performed using Google Scholar and the other medical-related databases, a comprehensive literature review was done to assess, critically examine, as well as synthesize the information that was obtained from these platforms. Instead of an Internet-wide search though, these databases came in handy when narrowing the search to specific articles on GDM.

The systematic review carried out in this paper entailed a search strategy to assess and find articles for inclusion and eligibility through the application of various filters and keywords. The search was based on several key terms that included gestational diabetes mellitus, pharmacological therapy, exercise, balanced diet, and lifestyle modification. Several combinations of these key words were used to find the relevant sources in answering or addressing the research question. With the appearance of many articles after a preliminary search, only the scholarly and peer-reviewed papers on these topics were chosen.

Another important filter when searching for articles entailed a strict definition of the time frame for narrowing in on the most relevant publications to be used. In most academic writing and for professionalism purposes, the literature sought after is usually that which falls within five years of the current date. Therefore, the publications used in this case had to be those between 2013 and 2018.

Results
The articles included in this paper were mostly original research studies conducted using randomized clinical control tests or trials for empirical data and quantitative analysis. The articles used can be described as formulating evidence-based recommendations when it comes to lifestyle modification as a way of controlling GDM. Therefore, the empirical nature of the studies shows that logical conclusions could be drawn from the results obtained when conducting the randomized control trials.

The PICO question identified the pregnant women as the population being studied with the themes of obesity and being overweight featuring prominently in the literature. These themes are considered as significant risk factors for the development of GDM. The theme of pharmacological therapy also features a lot with insulin-related treatment being considered in how it compares to the proposed intervention, which is lifestyle modification. According to the literature, lifestyle modification mostly features exercise and dietary considerations. Improved health outcomes are captured in the preventive theme that is abundant in the literature, even as most studies performed randomized clinical trials.

The underlying assertion or prevalent theme from responding to the PICO question is that of prevention being better than cure. GDM is a special type of DM that has been receiving increased attention among clinicians due to its dire consequences for mothers and babies. Different therapies, pharmacological (insulin) and non-pharmacological (nutrition/diet and exercise) are necessary in the treatment and management of patients with GDM (Wang et al., 2017).

Pharmacological therapies are instituted once the patient has presented with symptoms of DM when pregnant. Non-pharmacological therapies can be adopted even before diagnosis with the disease. Therefore, the non-pharmacological therapies compare favorably to their pharmacologic counterparts since they offer more preventive care that has better or improved overall health outcomes.

GDM is a medical condition that is frequently witnessed during pregnancy and often described as the intolerance to glucose upon conception (Benhalima et al., 2015). Since physical exercise is an excellent way of controlling weight and staying healthy, healthcare professionals are increasingly recommending this for GDM prevention and management (Kgosidialwa et al., 2015).

Eating a balanced diet at the correct time is also helpful in the attainment of glycemic control while reducing treatment costs by eliminating the need for insulin (Kanani & Leuva, 2017). At the moment, the initial treatment for GDM is medical nutrition therapy with more randomized controlled trials needed for the comparison of various dietary strategies (Moreno-Castilla et al., 2013). Regular exercise also potentially lowers the risk of developing GDM and can be employed during pregnancy (Moreno-Castilla et al., 2013). 

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