Framing the Results for Patients
The authors were clear that the analysis was exploratory and not prespecified and that it did not change the null conclusion of the primary trial. Insulin use was analyzed as a yes-or-no outcome, without its timing, dose, or duration, so the authors cautioned that favorable comparisons should not be read as eliminating insulin use. The trial also did not test metformin, which started only after an inadequate response to nutrition therapy.1
For pharmacists dispensing metformin during pregnancy, the EMERGE approach of starting low and titrating to the maximum tolerated dose offers a practical reference for counseling on tolerability and adherence. Notably, the trial excluded individuals with intolerance of or contraindication to metformin.1
Gestational Diabetes History Linked to Advanced CKM Stages
The AHA abstract comes from investigators at the University of California, Davis, and Emory University. They analyzed National Health and Nutrition Examination Survey (NHANES) data from 2007 to March 2020 for 11,181 women aged 30 to 79 years with at least 1 prior pregnancy, representing a weighted 69.9 million women. About 8% reported a history of gestational diabetes. CKM stages were classified using 2023 AHA criteria, which range from stage 0, reflecting no risk factors, to stage 4, reflecting established cardiovascular disease.2,3
The results were adjusted for sociodemographic and behavioral factors. Women with a history of gestational diabetes had a lower predicted probability of stage 0 (relative risk [RR], 0.58; 95% CI, 0.38-0.79) and stage 1 (RR, 0.70; 95% CI, 0.55-0.85) CKM syndrome. They were also observed to have a higher probability of stage 4 (RR, 1.55; 95% CI, 1.13-1.97). Most women in both groups fell into stage 2, with no significant difference after adjustment, and stage 3 showed a similar but nonsignificant pattern.2
The authors described gestational diabetes as an early sentinel event for long-term CKM progression and called for sustained risk surveillance and targeted prevention. Gestational diabetes history was self-reported, and the data were cross-sectional. The authors also recommended that longitudinal studies are needed to characterize progression after diagnosis.2
For pharmacists, a history of gestational diabetes noted during a medication review or screening encounter may be a cue to ask about follow-up for blood pressure, glucose, lipids, and kidney function. That fits the AHA framework’s emphasis on preventing progression across CKM stages.3
