A novel insulin sensitivity index particularly suitable to measure insulin sensitivity during gestation
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance developing or first recognized during pregnancy that is not clearly overt diabetes . It affects from 5–6 up to 15–20% of pregnancies worldwide, depending on population demographics, screening methods, diagnostic criteria in use, and maternal lifestyle . GDM is characterized by a defective insulin secretion and insulin resistance even in early pregnancy [3, 4]. Left untreated, GDM can complicate pregnancy, affecting neonatal growth and maternal health, and causing macrosomia, fetal congenital anomalies, intrauterine fetal death, neonatal hypoglycemia, neonatal hyperbilirubinemia, birth trauma, preeclampsia, premature delivery . GDM is also associated with long-term consequences for the women. They have an increased risk of type 2 future diabetes, in particular in the presence of obesity, insulin treatment during pregnancy, and a family history of diabetes . They also have a greater than threefold risk of metabolic syndrome compared to women with normal glucose tolerance in pregnancy . A multidisciplinary team operating in a secondary or tertiary care setting is a commonly adopted model for the provision of pregnancy care to women with diabetes. In fact, in the literature, there are evidences that demonstrated that a systematic multidisciplinary management of pregnant women in the diagnosis and treatment of GDM is essential to contain these maternal and fetal complications . The universal implementation of this best practice could transform the outcomes for women with GDM. But, on the basis of clinical experience, the organization of outpatient clinic and the composition of the multidisciplinary team vary according to local circumstances. These circumstances can lead to some problems in management of GDM patient decreasing the quality of patients’ management. The Italian DAWN Study Group on Pregnancy performed a survey to evaluate the wishes and the needs of Italian and immigrant women affected by GDM. The results showed that all women received structured care from a multidisciplinary team comprising diabetologists, experienced nurses, and dietitians. On the other hand, gynecologists and diabetes specialists cooperated in only 25–26% of cases, and 73% of pregnant women felt that a better cooperation between practitioners is the best way to improve the care available to pregnant women with GDM . To overcome the weaknesses of multidisciplinary teams operating at different diabetic outpatient clinics in different Italian regions, enabling them to facilitate task sharing and standardize their GDM patient management, we conducted a training experience. Our clinic adopt a multidisciplinary team approach meeting the standards recommended in national and international guidelines, so our team experienced in GDM management, including a diabetologist, a nurse, a dietitian, and a gynecologist, was the trainer team of the experience. A total of 13 multidisciplinary teams comprising a diabetologist, a nurse, a dietitian, and a gynecologist operating at different diabetic outpatient clinics of 5 Italian regions (Veneto, Lombardia, Emilia Romagna, Trentino Alto Managed by Antonio Secchi.