| BACKGROUNDGestational diabetes means that occur during pregnancy or the first discovery of different degree of abnormal glucose tolerance, not including prior to the pregnancy diagnosis of diabetes.The definition and diagnostic criteria of gestational diabetes, in constant development, perfecting the controversial discussion.According to epidemiological survey from all over the world, the incidence of gestational diabetes there are significant differences between RACES, because there is no uniform diagnostic criteria, international domestic nor recommended standard, coupled with the unceasing change of diagnostic criteria, therefore, the reported incidence of six to one, is 1%-14%, in our country rates of 1% to 4%, and the trend of rising year by year. In view of the increasing incidence of gestational diabetes and serious harmfulness, therefore, timely and effective treatment is especially important.At present, to the pathogenesis of gestational diabetes is not entirely clear, according to the latest research progress of the disease may be associated with genetic susceptibility, fat factor, chronic inflammation, obesity, physical activity, diet, pregnant age, and psychosocial stress and so on. For gestational diabetes can lead to a series of mother and son increased incidence of pregnancy complications, including: huge, intrauterine fetus chronic hypoxia, abnormal fetal heart development, hydramnios, premature rupture of membranes, preterm birth, neonatal hypoglycemia, and so on and so forth. Only in the entire pregnancy, maternal blood sugar to normal range, control can improve the end of the gestational diabetes, pregnant women mother, son. The current clinical treatments include diet therapy, exercise therapy, such as insulin use, it should be pointed out that, insulin treatment should be carried out on the basis of diet therapy, whether the effect is not satisfied. Diet, exercise and other non-drug treatment of gestational diabetes is irreplaceable and effective, is also the main treatment method, the control of blood sugar, reduce perinatal maternal complications and reduce the dosage of insulin has definite clinical effect; Oral medications because its may cause teras, macrosomia, neonatal hypoglycemia, and even death reason in the existence of the big controversy, the use of gestational diabetes in our country is still in insulin as gestational diabetes medication only, but the best therapeutic doses of insulin, there is no uniform standard, domestic and foreign scholars generally think that insulin dosage should be individualized, placental hormone level and with the progress of the pregnancy and effects on insulin sensitivity, timely adjust the dose of insulin. Clinically, patients with gestational diabetes now is given priority to with your eating and exercise, when eating after the exercise intervention, blood sugar is still unable to up to the standrad, need to use insulin to keep blood sugar under control as soon as possible. There is no denying the fact that also has obtained certain result. Existing treatments tend to ignore the impact of the pregnant women of the most common psychological stress.Gestational diabetes blood glucose characteristics as follows:the postprandial blood glucose faster, it’s easy to have a low blood sugar on an empty stomach and night. So gestational diabetes blood sugar control treatment scheme selection, should guarantee the normal fetal development and provide the mother during pregnancy, calories and nutritional needs, avoid postprandial hyperglycemia or hunger ketosis, in normal blood sugar control scheme. Considering the pregnancy is a special physiological stage, pregnant women emotional tension, blood sugar level fluctuations, thus increases the difficulty to control blood sugar, help improving maternal psychological adjustment, reduce the melancholy, make them actively cooperate with diet and other treatment, is conducive to the regulation of blood sugar. So as to achieve smooth control blood sugar, prevent hypoglycemia occurs. But the psychotherapy research was still in the stage of development, a large amount of queue sex clinical studies are required to confirm its therapeutic effect. The above each factors are associated with the incidence of gestational diabetes, but so far, with any of these causes are unable to explain the mechanism of gestational diabetes alone, could be the result of the interaction between various factors. Most scholars believe that the disease is the result of the comprehensive factors, and in the study of the pathogenesis of gestational diabetes, psychosocial stress research, in recent years found that serotonin (5-HT) directly or indirectly involved in the psychological adjustment, the study found that in patients with gestational diabetes, SCL-90 score and positively related to the level of plasma 5-HT in the patients with gestational diabetes, the changes in content of 5-HT is bad psychological status of patients with the disease is an important link, its important role in the evaluation of psychological intervention.In treatment, considering the particularity of pregnancy, gestational diabetes diagnosis, should be given priority to with lifestyle intervention, medication under the lifestyle intervention is still poorly controlled blood sugar. And evaluation research on the effects of psychological intervention treatment is relatively insufficient, the existing research in this field is also disease diagnosis standard is not unified, less sample content, lack of symptoms accepted unified grading quantitative indicators and standard of curative effect evaluation, observation time is limited, the lack of long-term follow-up, without basic research as a support, etc., so it can’t clear its therapeutic mechanism. According to this study for gestational diabetes diagnosis, issued in 2011, our country industry standards, and reference to the American diabetes association in 2013, the relevant provisions of the standard of diagnosis and treatment of gestational diabetes, as the reference, compare the three groups in the treatment of gestational diabetes, to observe the psychological intervention treatment curative effect.Abstract Objective:Clinical treatment of gestational diabetes in three ways, to observe its effect in reducing fasting blood glucose, 1h,2h glucose levels, Glycosylated hemoglobin A1C and serum 5-HT levels after OGTT, improve the patient’s condition to improve long-term efficacy and other aspects, objective evaluation its clinical efficacy, trying to explore the mechanism of action of psychotherapy, thus providing a theoretical basis for clinical application.Methods:The treatment time sequentially numbered, according to a random number table split into groups. According to estimates of sample size and sample 15% off cases considered, the proposed control group, experimental group A test group B, group C test each 37 cases. Control group was given a simple lifestyle intervention. A test group of patients on the basis of lifestyle intervention on the use of insulin injection (NovoRapid Penfill), three times a day, injected NovoRapid Penfill before each meals subcutaneously. Test B patients on the basis of lifestyle intervention with psychological intervention. Test C group lifestyle intervention, psychological intervention, the three insulin combination therapy.Simple lifestyle intervention group patients (control group) to take health promotion, exercise and diet guidance with intervention therapy. In family upper limbs motion (30 min a day, three times a day) and walking (40 min every day, after a meal after 1 h) is given priority to, the combination of dietary respect have a dietitian specialized guidance and function of carbohydrate, protein, fat than about 4:3:3.Lifestyle intervention+insulin group (experimental group A) on the basis of the patients in the control group used the insulin injection aspart, NovoRapidPenfill, production batch number:CVG0519), three meals A day before the subcutaneous injection, small dose of 1-2 units, then according to the monitoring of blood sugar, adjust the dosage. Such as fasting blood sugar is still not up to standard, or greater tendency for 5.3mmol/L, for use NPH, small doses, according to the dose adjustment of blood sugar.Lifestyle intervention+psychological intervention group (experimental group B) patients in group A with psychological intervention treatment, on the basis of the specific method is:the psychological intervention by the therapist specialist is responsible for education in patients with gestational diabetes, explain the causes, consequences, and preventive measures, bring home to the gestational diabetes patients have significant harm on maternal and perinatal, should attach importance to it. For some associated with irritable, the mood depressed mood disorders such as gestational diabetes patients by the lines of communication channel, alleviate or eliminate patients undeserved, appropriate cognitive behavioral therapy in serious psychological disorder.Lifestyle intervention, psychological intervention and insulin group (trial group C) patients in group A and on the basis of treatment with insulin and psychological intervention. Four groups of patients, treatment 2 weeks for an observation and detection, a total of four courses, and at the end of the course (8 weeks) to visit four groups of patients.Observed among the three experimental group and control group and test group patients,1 h,2 h after OGTT fasting glucose, glycosylated hemoglobin, blood sugar level changes of serum content of 5-HT and treatment of hypoglycemia, maternal and infant complications occurring in the process, the data collected by statistical processing, comparison and evaluation of three ways in the treatment of gestational diabetes.Statistical processing and the production of the CRF table:To all the participants in a clinical trial details may have been the benefits and risks, make the patient and family to fully informed, the consent of the patients agreed and signed written informed consent; According to the design requirements, unified form, detailed records; Carefully write cases observation table; A variety of data for statistical processing. Questionnaire data coded input computer, after processed by SPSS13.0 statistical analysis software, the prevalence rate expressed as a percentage, first on the sample data to normality test and f test.All data are used to (), said the inspection with P< 0.05 for statistical significance. For normal distribution, and variance together with the count of data using R* C table chi-square, chi-square test, Ridit analysis. Measurement data using t test; For skewness or unknown distribution types of data available nonparametric tests, such as rank and inspection, etc.Finally according to the requirements of design, production of CRF table:patients signed the informed consent, a detailed record, serious writing cases, observe adverse reactions or unexpected adverse reactions.Results:1, The baseline dataIn time to order number, according to random number table method were divided into control group and experiment group A, group B, the test group C 37 cases, due to the test in the process of treatment group A fall off in 2 cases, experimental group B fall off in 1 case, test group C fall off in 2 cases, the actual cases of control group of 37 cases, test A group of 35 cases, test, group B 36 cases test C group of 35 cases. The control group (1.64±0.21) m height, pregnancy weight (52.17±.17 kg, BMI (20.67±10.05 kg/m2, average age (28.53±8.49); Experimental group A (1.66±0.27) m tall and pregnancy weight (53.65±12.05 kg, BMI (21.09±9.39 kg/m2, average age (28.25±9.63); Experimental group B (1.65 ±0.31) m tall and pregnancy weight (52.88±.93 kg, BMI (20.93±9.57 kg/m2, average age (29.13±8.67); Test group C (1.66±0.19) m tall and pregnancy weight (53.97±12.41 kg, BMI (20.75±9.51 kg/m2, average age (28.45±9.01).2 Four groups of patients in fasting plasma glucose, OGTT 1 h,2 h, glycosylated hemoglobin t test with aspects respectively, the comparison between blood sugar and glycated hemoglobin level groups, are all P> 0.05, four groups of patients with blood sugar levels by t test, three group compared with control group, the blood sugar level exists obvious difference, the difference was statistically significant (P< 0.05); Test compared with the experimental group A and group B no obvious difference of the blood glucose levels and painted (P> 0.05), experiment group C and group B compared to the blood sugar level difference is apparent, was statistically significant (P< 0.05); being Test group C in the fasting blood glucose in patients with OGTT 1 h, 2 h, glycosylated hemoglobin aspects compared to the rest of the three groups, were statistically significant (P< 0.05)3 Before treatment in each group of fasting plasma glucose, OGTT 1 h blood glucose, blood sugar,2 h glycosylated hemoglobin,Group t test, respectively, the blood sugar and glycated hemoglobin levels between groups, are all P> 0.05, there was no statistically significant difference. Groups of patients with blood sugar levels after treatment by variance analysis and LSD-1 test, three experimental group compared with control group, the blood sugar level difference was statistically significant (P< 0.05); Compared experiment group A and group B, no obvious difference of the blood glucose levels and painted (P> 0.05), experiment group A and group C compared to the blood sugar level difference was statistically significant (P< 0.05); being Test group C in the fasting blood glucose in patients with OGTT 1 h,2 h, glycosylated hemoglobin aspects compared to the rest of the three groups, the difference was statistically significant (P< 0.05),4 After four courses of treatment, compared with the control group,3 group in lower serotonin levels have obvious difference, the difference was statistically significant (P < 0.05); Compared among the three experimental group, and there is statistical difference (P< 0.05);5 Three experimental group compared with control group the pregnancy outcome, in addition to the cesarean section rate is similar, several have obvious difference, the rest was statistically significant (P< 0.05);Five, four groups of patients in blood, urine, dung routine and so on liver and kidney function had no obvious effect;6 The use of insulin treatment of experimental group C has four patients appear edema, urticaria and other adverse reactions.after four courses of treatment, compared with the control group,3 group in lower serotonin levels have obvious difference, the difference was statistically significant (P < 0.05); Compared among the three experimental group, and there is statistical difference (P< 0.05).Conclusions:Insulin curative effect of gestational diabetes control blood glucose, and psychological treatment is one of effective treatment; Psychological intervention treatment is likely to be through improving patient serum serotonin (5-HT) levels, so as to achieve the aim of treatment for help control blood sugar; Lifestyle intervention with psychology, the comprehensive treatment of insulin, the glucose control level, to reduce the Glycated hemoglobin levels, improve the patients’ mental state, reduce maternal and infant complications in the most significant effect in general; Lifestyle intervention, insulin treatment and psychological intervention three treatment of hypoglycemia happening less, and corrected in a timely manner;Lifestyle intervention, insulin treatment and psychological intervention in three kinds of gestational diabetes treatment has fewer adverse reactions. Psychological intervention treatment or become a way of life, insulin treatment of the third kind of auxiliary control of the effective methods to gestational diabetes blood sugar. |
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