diabetestalk.net

New Gestational Diabetes Guidelines

Guidelines

Guidelines

There is now extensive evidence on the optimal management of diabetes, offering the opportunity of improving the immediate and long-term quality of life of those living with the condition. Unfortunately such optimal management is not reaching many, perhaps the majority, of the people who could benefit. Reasons include the size and complexity of the evidence-base, and the complexity of diabetes care itself. One result is a lack of proven cost-effective resources for diabetes care. Another result is diversity of standards of clinical practice. Guidelines are part of the process which seeks to address those problems. IDF has produced a series of guidelines on different aspects of diabetes management, prevention and care. The new IDF Clinical Practice Recommendations for managing Type 2 Diabetes in Primary Care seek to summarise current evidence around optimal management of people with type 2 diabetes. It is intended to be a decision support tool for general practitioners, hospital based clinicians and other primary health care clinicians working in diabetes. Pocket chart in the format of a Z-card with information for health professionals to identify, assess and treat diabetic foot patients earlier in the "window of presentation" between when neuropathy is diagnosed and prior to developing an ulcer. The content is derived from the IDF Clinical Practice Recommendations on the Diabetic Foot 2017. Available to download and to order in print format. The IDF Clinical Practice Recommendations on the Diabetic Foot are simplified, easy to digest guidelines to prioritize health care practitioner's early intervention of the diabetic foot with a sense of urgency through education. The main aims of the guidelines are to promote early detection and intervention; provide the criteria for Continue reading >>

Diabetes Mellitus In Pregnancy: Screening And Diagnosis

Diabetes Mellitus In Pregnancy: Screening And Diagnosis

INTRODUCTION Pregnancy is accompanied by insulin resistance, mediated primarily by placental secretion of diabetogenic hormones including growth hormone, corticotropin-releasing hormone, placental lactogen, and progesterone. These and other metabolic changes ensure that the fetus has an ample supply of nutrients. (See "Maternal adaptations to pregnancy: Endocrine and metabolic changes".) Gestational diabetes develops during pregnancy in women whose pancreatic function is insufficient to overcome the insulin resistance associated with the pregnant state. Among the main consequences are increased risks of preeclampsia, macrosomia, and cesarean delivery, and their associated morbidities. The approach to screening for and diagnosis of diabetes in pregnant women will be reviewed here. Management and prognosis are discussed separately: Continue reading >>

Gestational Diabetes - Symptoms, Diagnosis, Treatment

Gestational Diabetes - Symptoms, Diagnosis, Treatment

Diabetes is diagnosed when a person has too much glucose (sugar) in the blood. Gestational diabetes is a variation of the disease that occurs during pregnancy, and is the result of the mother not being able to produce enough insulin. Gestational diabetes may not present obvious symptoms but may be diagnosed during routine pregnancy screening. The condition can adversely affect the pregnancy and health of the baby but can be managed with diet modification and exercise and, if necessary, medication. General information Diabetes mellitus (commonly known as diabetes) is a group of diseases characterised by high blood glucose levels over a prolonged period of time. This page deals with gestational diabetes. Other variations of diabetes include: Type 1 diabetes – usually diagnosed in childhood or adolescence. Type 2 diabetes – associated with a person being overweight. Gestational diabetes accounts for 90% of cases of diabetes in pregnancy, while pre-existing type 2 diabetes accounts for 8% of such cases. It usually develops during the second half of pregnancy but can occur as early as the 20th week. Gestational diabetes is common, with 3000–4000 women being diagnosed with the condition or its recurrence each year in New Zealand. The prevalence of gestational diabetes is increasing (8–9% per year) and is higher in Māori (5–10%), Pacific peoples (4–8%), and Asian Indians (4%) than in New Zealand Europeans (3%). The increasing rate of gestational diabetes appears to be related to increasing rates of obesity. Causes The exact cause of gestational diabetes is not known. However, pregnancy does affect how the body metabolises (breaks down) glucose. Glucose is absorbed into the bloodstream following a meal. The body then uses insulin (a hormone produced by the pancreas Continue reading >>

Effect Of The New Diagnostic Criteria For Gestational Diabetes Mellitus Among Japanese Women

Effect Of The New Diagnostic Criteria For Gestational Diabetes Mellitus Among Japanese Women

Abstract The new diagnostic criteria for gestational diabetes mellitus (GDM), proposed by the International Association of Diabetes and Pregnancy Study Groups in 2010, were recently accepted in Japan. Therefore, the frequency of GDM is four times higher than previously recorded. This means that GDM has become a more clinically important disease. This study aimed to assess how the number of patients with GDM as well as its complications have changed after adoption of the new criteria. A total of 3,610 pregnant women in the Japan Assessment of GDM Screening Trial and Okayama University Hospital were included. We analyzed the prevalence of GDM and its complications using the old and new criteria. The prevalence of perinatal outcomes was increased by adopting the new criteria. There were many important perinatal complications in the additional new GDM criteria; therefore, patients with mild GDM, such as one-point disorder patients, should have careful interventions. Admission to the neonatal intensive care unit was significantly increased (p = 0.01) according to the new GDM criteria because the old criteria were stricter than the new ones. GDM patients with obesity (BMI ≥ 25 kg/m2) had a high frequency of perinatal complications that could require active intervention and strict follow-up. Because the new GDM criteria greatly affect perinatal complications, intervention for GDM starting at an early stage and strict follow-up (especially GDM with obesity) are important for reducing complications as well as the incidence of diabetes and metabolic syndrome in the mother and child. Continue reading >>

Diagnosis Of Gestational Diabetes Mellitus (gdm) In Australia

Diagnosis Of Gestational Diabetes Mellitus (gdm) In Australia

For over 20 years, the diagnosis of GDM in Australia has been derived from an ad hoc consensus, based on very limited data available at that time.1 The landmark observation trial HAPO, 20082 and other important randomised trials (Crowther et al. 20053; Langdon et al. 20094) have led to recommendations for new criteria for the diagnosis of GDM5, which have been endorsed by the World Health Organisation (WHO). Locally, these criteria have been endorsed by the Australasian Diabetes in Pregnancy Society (ADIPS) and the Australian Diabetes Society (ADS) but not by the Endocrine Society of Australia (ESA) or the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ). The result is that there are currently two sets of GDM diagnostic criteria in use – causing significant confusion amongst obstetricians, midwives, pathologists and patients. On 1 November 2013, RANZCOG convened a multidisciplinary working party to progress the issue of variation in diagnosis of GDM (the Australian Multidisciplinary Gestational Diabetes Working Party). This working party included representation from: The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), The Australasian Diabetes in Pregnancy Society (ADIPS), The International Association of the Diabetes and Pregnancy Study Groups (IADPSG), The Royal College of Pathologists of Australasia (RCPA), The Australian College of Midwives (ACM), The Australian Diabetes Educators Association (ADEA), The Australian Diabetes Society (ADS), The Society of Obstetric Medicine of Australia and New Zealand (SOMANZ), and Consumer representation. Representatives from the Endocrine Society of Australia (ESA), The Australian College of Rural and Remote Medicine (ACRRM) and the Royal Australian College of General Pra Continue reading >>

Diabetes Criteria 'miss At-risk Women'

Diabetes Criteria 'miss At-risk Women'

New criteria for diagnosing diabetes during pregnancy could be missing thousands of at-risk women, a report suggests. Although the threshold introduced by health watchdog NICE earlier this year has been lowered, Cambridge University research says it is still too high. The WHO's threshold is lower and identifies more women at risk of pregnancy complications. Diabetes UK said it was vital that women received the right support. Diabetes that occurs for the first time during pregnancy is known as gestational diabetes. It is estimated to affect around 4%-5% of pregnant women in the UK and has becoming increasingly common in line with the rise in obesity. In some women, the condition occurs because the body cannot produce enough insulin to meet the extra needs of pregnancy. In others, diabetes may be found during the first trimester of pregnancy or may have existed before the pregnancy. If left untreated, the condition can be a risk to the health of the mother and baby, potentially leading to birth defects, babies being born overweight and emergency C-sections. Miscarriage is also a danger. The WHO criteria were not cost effective - their criteria did not provide enough benefit in relation to the increased costsProf Mark Baker, NICE Different thresholds The National Institute for Health and Care Excellence (NICE) brought in new guidelines in February, requiring two blood tests (one when fasting and another two hours after a sugary drink). A fasting blood sugar test reading of 5.6 mmol per litre or above is required for a diagnosis of gestational diabetes. The World Health Organization guidelines require three blood tests and a slightly lower reading of 5.1 mmol per litre for the fasting blood sugar test. Study author Dr Claire Meek from the Wellcome Trust-MRC Institute of Met Continue reading >>

Monitoring Diabetes Before, During And After Pregnancy

Monitoring Diabetes Before, During And After Pregnancy

View / Download pdf version of this article What is new? All pregnant women should be tested for undiagnosed diabetes using HbA1c prior to 20 weeks’ gestation Pregnant women with HbA1c ≥ 50 mmol/mol should be referred to a diabetes in pregnancy clinic Pregnant women with HbA1c 41 – 49 mmol/mol should be offered lifestyle advice to reduce risks of adverse maternal and fetal outcomes; local protocols may recommend that these women are also referred to a diabetes in pregnancy clinic At 24 to 28 weeks’ gestation, women are recommended to undergo an oral glucose tolerance testing regimen, which is dependent on their initial HbA1c result HbA1c is used to monitor glycaemia postpartum in women who have had gestational diabetes, beginning at three months after birth Pregnancy is a time of significant metabolic change when a woman’s physiology adapts to meet the challenges of gestation. Insulin sensitivity is decreased by as much as 50 to 60% during pregnancy, a level comparable to that seen in people with type 2 diabetes or impaired glucose tolerance.1 This change in insulin sensitivity is thought to be caused by endocrine signals from the growing placenta, and has evolved to aid fetal development.2 During pregnancy the mother’s pancreas typically responds with beta-cell and islet hyperplasia to enable greater insulin production and regulate blood glucose levels.1 Women who do not produce enough insulin to compensate for this transitory increase in insulin resistance develop gestational diabetes. These women often have risk factors for the development of type 2 diabetes and a higher level of insulin resistance before pregnancy.1 After childbirth, the insulin resistance associated with pregnancy usually resolves, as does the need for treatment, if this has been requir Continue reading >>

Gestational Diabetes

Gestational Diabetes

What risk factors are associated with GDM? Factors that may impact a woman’s GDM diagnoses during pregnancy include: Obesity and being overweight A family history of type 2 diabetes (including parent or sibling) Cultural backgrounds can influence your risk including Aboriginal or Torres Strait Islanders, Indian, Vietnamese, Chinese, Middle Eastern or Polynesian Gestational diabetes occurred during previous pregnancies Your age – you are at greater risk of GDM if you are 30 years old or older Unexplained stillbirth or neonatal deaths or having a very large infant previously could put the mother at greater risk When will I be tested for GDM? A test called an oral glucose tolerance test (OGTT) is used to diagnose GDM and involves a blood test before breakfast, then again two hours after a glucose drink. This test generally occurs in the 24th – 28th week of pregnancy. Usually gestational diabetes goes away after your baby is born and you should be able to cease taking any associated medication (tablets or insulin). Before you are discharged to the care of your GP, your blood will be tested to make sure the glucose levels have returned to normal. You should have a fasting blood test six weeks after your baby is born and then every year. Looking after gestational diabetes is important to prevent complications during pregnancy and childbirth. Management for GDM includes: A dietitian who will help you with a healthy eating plan that meets the nutritional requirements of pregnancy and is appropriate for your blood glucose levels An exercise physiologist or local doctor will recommend regular physical activity to help your body’s insulin work better. It also helps manage blood glucose levels Frequent blood glucose monitoring will help manage blood glucose levels to stay i Continue reading >>

Gestational Diabetes Uk

Gestational Diabetes Uk

Gestational Diabetes UK is dedicated to offering support and evidence based research to women diagnosed with gestational diabetes in the UK and Republic of Ireland. If you have been diagnosed, or are going to be tested for gestational diabetes and want a support network and community for help, advice and to discuss all things related to gestational diabetes, then please join our Facebook support group, Gestational Diabetes UK. What is gestational diabetes? Diabetes is caused by too much glucose (sugar) in the blood. The amount of glucose in the blood is controlled by a hormone called 'insulin'. During pregnancy, the body produces a number of hormones, such as oestrogen, progesterone and human placental lactogen (HPL). These hormones make the body insulin resistant, which means the cells respond less well to insulin and the level of glucose in the blood remains high. To cope with the increased amount of glucose in the blood, the body should produce more insulin. However, some women either cannot produce enough insulin in pregnancy to transport the glucose into the cells, or their body cells are more resistant to insulin. This is known as 'gestational diabetes mellitus'. Gestational diabetes can be defined as carbohydrate intolerance. Gestational diabetes is usually diagnosed by having a OGTT/GTT (oral glucose tolerance test) between 24 - 28 weeks, however women showing symptoms or those that have higher risks of developing gestational diabetes may be tested earlier. Gestational diabetes affects around 5% of UK pregnancies Are some women at a higher risk of getting gestational diabetes than others? You have an increased risk of gestational diabetes if: your body mass index (BMI) is 30 or more you have previously had a baby who weighed 4.5kg (10lbs) or more at birth you ha Continue reading >>

New Nice Guidelines ‘could Miss’ Gestational Diabetes Diagnosis

New Nice Guidelines ‘could Miss’ Gestational Diabetes Diagnosis

Women at risk of gestational diabetes could be overlooked because of new healthcare guidelines, according to a new study. Researchers at the University of Cambridge and Cambridge University Hospitals Foundation Trust believe the newly introduced gestational diabetes guidelines, set by the National Institute for Health and Care Excellence (NICE), could miss vital information needed for a diagnosis. Dr Meek from the Wellcome Trust-MRC Institute of Metabolic Science at the University of Cambridge said there is a “fundamental difference” between the new criteria and the guidelines laid out by the World Health Organization (WHO) when it comes to identifying women who could be at risk. He said: “The international criteria are based on minimising the risk of harm to the mother and baby, whereas the NICE criteria have been based upon reducing costs to the NHS.” In February the NICE guidelines introduced the guidelines which recommended using a less strict fasting blood sugar threshold for the diagnosis. But the research, which was carried out on 25,000 women who gave birth in Cambridge between 2004 and 2008, found that those who had borderline levels of fasting blood sugar were at a much higher risk of having a heavier baby. They were also twice as likely to have an emergency Caesarean section and seven times more likely to develop excessive amniotic fluid. All those women would have been missed under the NICE criteria. Using the WHO guidelines, which required one test to be taken in the fasting state and a further two other tests taken one and two hours after a drink containing sugar, would have resulted in 126 more diagnoses of gestational diabetes over five years. Dr David Simmons, from Cambridge University Hospitals, said: “Doctors need to be aware that the new NI Continue reading >>

Acog Guidelines At A Glance: Gestational Diabetes Mellitus

Acog Guidelines At A Glance: Gestational Diabetes Mellitus

Committee on Practice Bulletins—Obstetrics ACOG Practice Bulletin 137: Gestational Diabetes Mellitus, August 2013 (Replaces Practice Bulletin Number 30, September 2001, Committee Opinion Number 435, June 2009, and Committee Opinion Number 504, September 2011). Obstet Gynecol. 2013;122:406-16. Full text of ACOG Practice Bulletins is available to ACOG members at _Bulletins_--_Obstetrics/Gestational_Diabetes_Mellitus. Gestational diabetes mellitus Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. Debate continues to surround both the diagnosis and treatment of GDM despite several recent large-scale studies addressing these issues. The purpose of this document is to 1) provide a brief overview of the understanding of GDM, 2) provide management guidelines that have been validated by appropriately conducted clinical research, and 3) identify gaps in current knowledge toward which future research can be directed. Used with permission. Copyright the American College of Obstetricians and Gynecologists. By Haywood L. Brown, MD Dr. Brown is Roy T. Parker Professor and Chair, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke Medicine, Durham, NC. He is also a member of the Contemporary OB/GYN Editorial Board. Practice Bulletin 137 on gestational diabetes mellitus provides a rationale for current screening guidelines for a pregnancy population in which prevalence of obesity and Type 2 diabetes has increased over the past several decades. Review of the bulletin underscores several questions pertinent to diagnosis and management, which are reflected by and addressed similarly in the evidence-based recommendations in the document.1 Is GDM overdiagnosed or underdiagnosed? Obviously, the prevalence of gest Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

Key Messages Pregestational Diabetes All women with pre-existing type 1 or type 2 diabetes should receive preconception care to optimize glycemic control, assess complications, review medications and begin folate supplementation. Care by an interdisciplinary diabetes healthcare team composed of diabetes nurse educators, dietitians, obstetricians and diabetologists, both prior to conception and during pregnancy, has been shown to minimize maternal and fetal risks in women with pre-existing type 1 or type 2 diabetes. Gestational Diabetes Mellitus The diagnostic criteria for gestational diabetes mellitus (GDM) remain controversial; however, the committee has chosen a preferred approach and an alternate approach. The preferred approach is to begin with a 50 g glucose challenge test and, if appropriate, proceed with a 75 g oral glucose tolerance test, making the diagnosis of GDM if ≥1 value is abnormal (fasting ≥5.3 mmol/L, 1 hour ≥10.6 mmol/L, 2 hours ≥9.0 mmol/L). The alternate approach is a 1-step approach of a 75 g oral glucose tolerance test, making the diagnosis of GDM if ≥1 value is abnormal (fasting ≥5.1 mmol/L, 1 hour ≥10.0 mmol/L, 2 hours ≥8.5 mmol/L). Untreated GDM leads to increased maternal and perinatal morbidity, while treatment is associated with outcomes similar to control populations. Highlights of Revisions All recommendations have been updated and reorganized to clarify management considerations for women with pregestational or gestational diabetes in the prepregnancy period, during pregnancy, and in the intrapartum and postpartum periods. New criteria have been added for the screening and diagnosis of GDM (Figures 1 and 2). Figure 1 Preferred approach for the screening and diagnosis of gestational diabetes. Figure 2 Alternative approach f Continue reading >>

Natural Selection? The Evolution Of Diagnostic Criteria For Gestational Diabetes

Natural Selection? The Evolution Of Diagnostic Criteria For Gestational Diabetes

Gestational diabetes is a common pregnancy disorder which is generally managed with diet, exercise, metformin or insulin treatment and which usually resolves after delivery of the infant. Identifying and treating gestational diabetes improves maternal and fetal outcomes and allows for health promotion to reduce the mother’s risk of type 2 diabetes in later life. However, there remains considerable controversy about the optimal method of identification and diagnosis of women with gestational diabetes. The NICE-2015 diagnostic criteria (75 g oral glucose tolerance test (OGTT) 0 h ≥5.6 mmol/L; 2 h ≥7.8 mmol/L) are based upon cost-effectiveness estimates using observational data, while the WHO-2013 criteria (75 g OGTT 0 h ≥5.1 mmol/L; 1 h ≥10.0 mmol/L; 2 h ≥8.5 mmol/L) identify women and infants at risk of adverse outcomes according to prospective data. There is also considerable controversy about testing for gestational diabetes using universal or risk factor-based screening, and when and how testing should be performed. The aim of this review is to provide a summary of the clinical biochemistry aspects to these debates and to highlight the importance of appropriate identification of gestational diabetes and subsequent type 2 diabetes in this population. 1. Metzger, BE, Coustan, DR. Summary and recommendations of the fourth international workshop – conference on gestational diabetes mellitus. The Organizing Committee. Diabetes Care 1998; 21(Suppl 2): B161–B167. Google Scholar, Medline 2. World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy, Geneva: WHO, 2013. Google Scholar 3. Simmons D. Epidemiology of diabetes in pregnancy. In: McCance DR, Maresh M and Sacks DA (eds) Practical Management of Diabet Continue reading >>

Gestational Diabetes Mellitus: Incorporating The New Dietary Guidelines

Gestational Diabetes Mellitus: Incorporating The New Dietary Guidelines

Graduate Student/Dietetic Intern Human Nutrition and Foods School of Medicine West Virginia University Morgantown, West Virginia Liz Quintana, EdD, RD, LD, CDE West Virginia University Morgantown, West Virginia Abstract Gestational Diabetes Mellitus (GDM) is a serious complication of pregnancy. Obesity increases the risk for GDM, and the increasing rate of obesity in the nation has led to more cases of GDM. The condition not only affects the mother, but can cause poor outcome in the infant. The 2010 Dietary Guidelines for Americans provide recommendations for pregnant women and current research further expounds on recommendations and guidelines that should be implemented in managing women with GDM. A registered dietitian certified diabetes educator (RD and CDE) shares a case study of a first-time visit with a GDM patient. Introduction Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance that is first recognized during pregnancy and develops in approximately 7% of all pregnancies (1,2). To identify more women with GDM and to reduce the health risks to the mother and fetus, the American Diabetes Association (ADbA) has adopted new guidelines for testing pregnant women for gestational diabetes. The International Association of Diabetes and Pregnancy Study Groups, which includes the ADbA, developed the new recommendations based on data from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study, which showed that the risk of maternal, fetal, and neonatal adverse effects increases directly with a mother’s glucose levels. The new criteria will increase the prevalence of GDM, because one abnormal value, not two, is sufficient to make the diagnosis. Table 1 outlines the new screening and diagnostic strategies (3). Although many factors contribute to the Continue reading >>

13.3 Gestational Diabetes Mellitus

13.3 Gestational Diabetes Mellitus

Clinical context Gestational diabetes, or GDM, is defined as glucose intolerance that begins or is first diagnosed during pregnancy. It may appear earlier, particularly in women with a high level of risk for GDM. GDM generally develops and is diagnosed in the late second or early third trimester of the pregnancy. GDM affects about 9.6–13.6% of pregnancies in Australia.245,246 The reported prevalence of GDM varies for a number of reasons. One reason is the use of different screening and diagnostic criteria. The prevalence is also affected by maternal factors such as history of previous gestational diabetes, ethnicity, advanced maternal age, family history of diabetes, pre-pregnancy weight and high gestational weight gain. Mothers of different ethnicity born in areas with high diabetes prevalence such as Polynesia, Asia and the Middle East, are three times as likely to have GDM as mothers born in Australia. Among Aboriginal and Torres Strait Islander mothers, GDM is twice as common, and pre-gestational diabetes affecting pregnancy is three to four times as common as in non-Indigenous mothers.245 In pregnancy, there is a natural increase in levels of hormones including cortisol, growth hormone, human placental lactogen, and progesterone and prolactin levels, causing two to three fold increases in insulin resistance. The action of these hormones is usually compensated by increased insulin release. In pregnant women with abnormal glucose tolerance or impaired β-cell reserve, the pancreas is unable to sufficiently increase insulin secretion in order to control BGLs. Potential maternal complications during pregnancy and delivery include pre-eclampsia and higher rates of caesarean delivery, maternal birth injury, postpartum haemorrhage. For the neonate, complications can inc Continue reading >>

More in diabetes