Nutrition Counselling For Gestational Diabetes/Suivi nutritionnel et diabète gestationnel

DAWNA ROYALL, EDITOR

In this issue we include a Public Policy Statement, entitled "Recommendations for Nutrition Best Practice in the Management of Gestational Diabetes Mellitus" (executive summary - full report available at: http://www.dietitians.ca/news/highlights _positions.asp). These recommendations are based on a systematic literature review conducted by four collaborating organizations: the Canadian Diabetes Association, Dietitians of Canada, Diab�te Qu�bec and the Ordre professionel des di�t�tistes du Qu�bec. The group examined evidence to answer the question, "What are the most effective nutrition recommendations for the treatment of gestational diabetes?" The recommendation with the best evidence (Grade A) was for nutrition counselling by a registered dietitian (as part of the multidisciplinary team) for women with gestational diabetes mellitus (GDM) to help them achieve their nutrition, diabetes and health goals. This recommendation is echoed in a recently released American Diabetes Association Position Statement, which recommends that all women with GDM receive medical nutrition therapy, provided by a dietitian, at the time of diagnosis (1).

These recommendations are largely based on the results of a recent controlled trial that randomized 1,000 women with GDM to receive dietary advice from a dietitian, blood glucose monitoring, and insulin therapy as needed, compared with routine care (2). The intervention reduced rates of perinatal complications (1% versus 4%) and improved health-related quality of life measures, demonstrating the efficacy of identifying and treating GDM. The recommendations published in this issue identify a number of areas for future research.

References

1. American Diabetes Association. Nutrition recommendations and interventions for diabetes-2006. A position statement by the American Diabetes Association. Diab Care 2006 [cited 2006 20 Sept]; 29(9):2140-57. Available from: http://care.diabetesjournals.org/cgi/reprint/29/9/2140.

2. Crowther CA, Miller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOlS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352(24):2477-86.

Suivi nutritionnel et diab�te gestationnel

Dans ce num�ro, nous publions le r�sum� (l'article complet peut �tre consult� � l'adresse suivante : http://www.dietitians.ca/news/highlights_ positions.asp) d'un �nonc� de politique intitul� � Recommendations for Nutrition Best Practice in the Management of Gestational Diabetes Mellitus �. Ces recommandations sont bas�es sur une compilation syst�matique des travaux publi�s men�e en collaboration par quatre organismes : l'Association canadienne du diab�te, les Di�t�tistes du Canada, Diab�te Qu�bec et l'Ordre professionnel des di�t�tistes du Qu�bec. Le groupe a examin� les donn�es scientifiques permettant de r�pondre � la question suivante : � Quelles sont les recommandations nutritionnelles les plus efficaces dans le traitement du diab�te gestationnel? � La recommandation fond�e sur les preuves les plus solides (cat�gorie A) portait sur le suivi nutritionnel prodigu� par un di�t�tiste professionnel (membre d'une �quipe multidisciplinaire) pour aider les femmes enceintes diab�tiques � atteindre leurs objectifs en mati�re de nutrition, de diab�te et de sant�. Cette recommandation est reprise dans un �nonc� de position publi� r�cemment par l'American Diabetes Association : toutes les femmes enceintes souffrant de diab�te devraient b�n�ficier d'un traitement nutritionnel dispens� par un di�t�tiste aussit�t le diagnostic pos� (1).

Ces recommandations sont largement fond�es sur les r�sultats d'un essai comparatif men� r�cemment o� un �chantillon al�atoire de 1000 femmes enceintes diab�tiques ont b�n�fici� des conseils d'un di�t�tiste, d'une surveillance de leur glyc�mie et d'un traitement � l'insuline si n�cessaire, comparativement � des soins de routine (2). L'intervention a permis de r�duire les taux de complications p�rinatales (1 % contre 4 %) et d'am�liorer les mesures de la qualit� de vie li�e � la sant�, d�montrant ainsi l'efficacit� du d�pistage et du traitement du diab�te gestationnel. Les recommandations publi�es dans ce num�ro font ressortir un certain nombre de domaines de recherche potentiels.

R�f�rences

1. American Diabetes Association. Nutrition recommendations and interventions for diabetes-2006. A position statement by the American Diabetes Association. Diab Care 2006 [cited 2006 20 Sept]; 29(9):2140-57. Available from: http://care.diabetesjonrnals.Org/cgi/reprint/29/9/2140.

2. Orowther CA, Miller JE, Moss JR, McPhee AJ.Jeffries WS, Robinson JS. Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352(24):2477-86.

2006-2007

Editorial Board

Comit� de r�daction

Marcia Cooper, PhD, RD, Ottawa, ON

Wendy Dahl, PhD, RD, Saskatoon, SK

Judith DeWolfe, PhD, RD, Kingston, ON

Marco Di Buono, PhD, Mississauga, ON

Heather Keller, PhD, RD, Guelph, ON

Daphne Lordly, MA, PDt, Halifax, NS

Catherine Mortey, PhD, RD, Vancouver, BC

Marie-Claude Raquette, PhD, DtP, Montreal, PQ