Backgraund: The Israeli-Georgian Program Diabetes in Pregnancy was initiated at the Georgian Diabetes Center in 1997, with the aim to provide care for women with diabetes.
The Program has become possible as a result of Twinning between Georgian Diabetes Federation and Israeli Diabetes Association, it was initiated in 1997, and since then it successfully works, being the longest and most sustainable Twinning program in Europe. 
The aim of the Program is to approximate pregnancy outcomes in diabetic women to that of the non-diabetic ones. And its goal is to assess the efficacy of treatment in women with pre-GDM  and  GDM.
Methods: In total, 374 women with type 1 preexisting diabetes ( mean age 23+6 yrs, diabetes durations 12.4+7.5 yrs) and 102 women with gestational diabetes (GDM) were enrolled in the study (Tabl.1). The patients were divided into   4 groups (Gr.): 
Gr.1 - 210 patients who received specialized pre-conception care; Gr.2 -105 patients enrolled in the program at < 10 weeks of gestation       (5.6+2.1 weeks); 
Gr.3 - 59 patients enrolled in the program at > 10 weeks of gestation (19.5+6.1 weeks); Gr.4 - 102 women  with GDM ( 20 – 32 weeks of gestations).
Results: At entry  HbA1c(%) levels for Gr.1, 2, 3 and Gr.4 were: 8.09 (0.08), 9.08 (0.8), 8.17 (1.6), 6.7(0.9) respectively (Tabl.1);  By the end of preconcetion care  HbA1c levels in Gr.1 - (6.4(0.98)%) were statistically lower in Gr.2 and 3 (P=0.000).  By term HbA1c levels  statistically decreased in all the groups (P=0.024, P=0.000, P=0.000, respectively), Fig.1.
 At entry percent of the preproliferative retinopathy for Gr.1, 2 and Gr.3 were: 8,09; 13.3 and 11,8%,respectively; by term the percent has not increased.
The rate of spontaneous abortions was lower in Gr.1 (1.9%), than in Gr.2 (7.61%)  P=0.0206.
In Gr.1  patients percent of macrosomia was lower, than in Gr.2 and Gr.3 ( P1-2 =0.0074; P1-3 = 0.0101); and in Gr. 1 and 4  (10.47 – 11.7%) – no statistical difference was observed (Fig.2).
In Gr.1  patients percent of pre-eclampsia and preterm deliveries before 37 weeks of gestation was lower, than in Gr.2 and Gr.3 (pre-eclampsia - P1-2 =0.0005; P1-3 = 0.0002; preterm deliveries P1-2 =0.0014; P1-3 = 0.0001). No statistical difference between Gr.1 and Gr.4 was revealed ( P1-4  =0.3748; and  =0.1141) (Fig.3).
Perinatal mortality was observed in Gr.1 – 1.42%,  in Gr.2 - 4.76% in Gr.3 - 8.47% and in Gr.4 -1.9% (P1-2 =0.0944; P1-3 = 0.0129; P1-4 =0.7265). Fig.4, Tabl.2.Fetal malformations (3.03%) were registered  only in Gr.3.      
Conclusion: In patients with Pre-GDM and GDM good glycemia control during pregnancy  significantly reduces the risk of spontaneous abortions, pre-eclampsia, preterm delivery, fetus malformations and perinatal deaths. No retinopathy progression is observed, when women are well-controlled throughout their pregnancies. This program shows that proper approach to pregnancy management in diabetes can be successfully implemented even in low-to-middle income countries.

Twenty years results of the Israeli-Georgian Program Diabetes in Pregnancy