diabetestalk.net

Target Hba1c Levels In Pregnancy

Diabetes Management Guidelines

Diabetes Management Guidelines

Source: American Diabetes Association. Standards of medical care in diabetes—2016. Diabetes Care. 2016;39(suppl 1):S1-S106. Available here. Refer to source document for full recommendations, including class of recommendation and level of evidence. Jump to a topic or click back/next at the bottom of each page Diabetes in Pregnancy (Gestational Diabetes) Glycemic Targets in Pregnancy Pregestational diabetes Gestational diabetes mellitus (GDM) Fasting ≤90 mg/dL (5.0 mmol/L) ≤95 mg/dL (5.3 mmol/L) 1-hr postprandial ≤130-140 mg/dL (7.2-7.8 mmol/L) ≤140 mg/dL (7.8 mmol/L) 2-hr postprandial ≤120 mg/dL (6.7 mmol/L) ≤120 mg/dL (6.7 mmol/L) A1C 6.0-6.5% (42-48 mmol/L) recommended <6.0% may be optimal as pregnancy progresses Achieve without hypoglycemia Recommendations for Pregestational Diabetes Pregestational type 1 and type 2 diabetes confer greater maternal and fetal risk than GDM Spontaneous abortion Fetal anomalies Preeclampsia Intrauterine fetal demise Macrosomia Neonatal hypoglycemia Neonatal hyperbilirubinemia Diabetes in pregnancy may increase the risk of obesity and type 2 diabetes in offspring later in life Maintain A1C levels as close to normal as is safely possible Ideally, A1C <6.5% (48 mmol/L) without hypoglycemia Discuss family planning Prescribe effective contraception until woman is prepared to become pregnant Women with preexisting type 1 or type 2 diabetes Counsel on the risk of development and/or progression of diabetic retinopathy Perform eye exams before pregnancy or in first trimester; monitor every trimester and for 1 year postpartum Management of Pregestational Diabetes Insulin is the preferred medication for pregestational type 1 and type 2 diabetes not adequately controlled with diet, exercise, and metformin Insulin* management during pre Continue reading >>

12. Management Of Diabetes In Pregnancy

12. Management Of Diabetes In Pregnancy

For guidelines related to the diagnosis of gestational diabetes mellitus, please refer to Section 2 “Classification and Diagnosis of Diabetes.” Pregestational Diabetes Provide preconception counseling that addresses the importance of glycemic control as close to normal as is safely possible, ideally A1C <6.5% (48 mmol/mol), to reduce the risk of congenital anomalies. B Family planning should be discussed and effective contraception should be prescribed and used until a woman is prepared and ready to become pregnant. A Women with preexisting type 1 or type 2 diabetes who are planning pregnancy or who have become pregnant should be counseled on the risk of development and/or progression of diabetic retinopathy. Eye examinations should occur before pregnancy or in the first trimester and then be monitored every trimester and for 1 year postpartum as indicated by degree of retinopathy. B Lifestyle change is an essential component of management of gestational diabetes mellitus and may suffice for treatment for many women. Medications should be added if needed to achieve glycemic targets. A Preferred medications in gestational diabetes mellitus are insulin and metformin; glyburide may be used but may have a higher rate of neonatal hypoglycemia and macrosomia than insulin or metformin. Other agents have not been adequately studied. Most oral agents cross the placenta, and all lack long-term safety data. A General Principles for Management of Diabetes in Pregnancy Potentially teratogenic medications (ACE inhibitors, statins, etc.) should be avoided in sexually active women of childbearing age who are not using reliable contraception. B Fasting, preprandial, and postprandial self-monitoring of blood glucose are recommended in both gestational diabetes mellitus and pregestati Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

Most women with type 1 or type 2 diabetes have healthy pregnancies and healthy babies, but the condition does require special management during pregnancy . Pregnancy places extra demands on a woman's body meaning diabetes needs to be carefully monitored and blood sugar levels well managed. Diabetes in pregnancy increases the risk of having a large baby, stillbirth , miscarriage , the need for a caesarean delivery and possible health problems for the child later in life. If you have diabetes and would like to get pregnant, there are steps you can take with your diabetes care team take to lessen the risks to you and your baby. As well as managing diabetes, the normal pre-pregnancy advice will be given to not smoke, avoid alcohol, have a healthy balanced diet, and to stay active. Preparing for pregnancy when you have diabetes If you have diabetes, discussing everything with your doctor before becoming pregnant is important. A doctor will look at HbA1c blood glucose readings to see how well controlled the diabetes has been over the past 2 to 3 months against individual targets. A woman with an HbA1c reading of more than 86mmol/mol will be advised to avoid pregnancy. Readings below 43mmol/mol may be recommended before pregnancy and targets adjusted during the pregnancy. Other diabetes tests before getting pregnant Having other medical tests before you become pregnant can also help your doctor monitor your health and help prevent the development of diabetic complications during pregnancy. Some of the tests your doctor may recommend include: An assessment of kidney function to screen for diabetic kidney complications Continue reading >>

Diabetes In Pregnancy

Diabetes In Pregnancy

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 2 Diabetes article more useful, or one of our other health articles. This article deals with pregnancy in patients with pre-existing diabetes. See also separate Gestational Diabetes article. Epidemiology Diabetes is the most common pre-existing medical disorder complicating pregnancy in the UK. Up to 5% of women giving birth in England and Wales have either pre-existing diabetes or gestational diabetes[1]. The number of people with type 1 diabetes and the prevalence of type 2 diabetes amongst women of child-bearing age are increasing. Pregnancies of women with diabetes are regarded as high-risk for both the woman and the baby[2]. Of women who have diabetes during pregnancy, it is estimated that approximately 87.5% have gestational diabetes, 7.5% have type 1 diabetes and the remaining 5% have type 2 diabetes[1]. Possible complications Diabetes in pregnancy is associated with risks to the woman and to the developing fetus[1]. Miscarriage, pre-eclampsia and preterm labour are more common in women with pre-existing diabetes. Diabetic retinopathy can worsen rapidly during pregnancy. Stillbirth, congenital malformations, macrosomia, birth injury, perinatal mortality and postnatal adaptation problems (eg, hypoglycaemia) are more common in babies born to women with pre-existing diabetes. Pre-conception care and good glucose control before and during pregnancy can reduce these risks. Increased risk of complications of diabetes Ketoacidosis may occur during the pregnancy. Progression of microvascular complications including retinopathy and nephropathy: poor Continue reading >>

Application Of Glycated Hemoglobin In The Perinatal Period

Application Of Glycated Hemoglobin In The Perinatal Period

Go to: Introduction Glycated hemoglobin (HbA1c) has been widely accepted as an indicator used to evaluate the blood glucose control in diabetes mellitus (DM) patients. However, evidence on the application of HbA1c in the diagnosis and follow up of gestational diabetes mellitus (GDM) and pregnancy combined DM is very poor. Herein, we summarize the available studies on this issue. Concept of HbA1c HbA1c is a special fragment formed by the binding of glucose to the C chain or D chain of hemoglobin A (HbA) and as a result of non-enzymatic catalysis of mature hemoglobin (Hb) and glucose. The synthesis of HbA1c is very slow and relatively irreversible. HbA1c can maintain in the whole lifespan (120 days) of red blood cells. The synthesis rate of HbA1c is positively rated to the glucose concentration of red blood cells and HbA1c can reflect the mean blood glucose level within past 8 to 10 weeks. The HbA1c is independent of accurate glucose detection, the acute change in blood glucose and the interval between prior meal and HbA1c detection. In addition, HbA1c detection has good repeatability, and is stable and not influenced by the time of blood collection, fasting status and use of insulin. In addition to self-measurement of capillary blood glucose, HbA1c detection is an established tool in the assessment of glycemic control [1]. In the 59th Annual Meeting of Diabetes Association of USA, HbA1c detection is recommended as a golden standard for evaluating the glucose control. HbA1c and normal pregnancy In non-pregnant women, the HbA1c is 4.7-6.3% [2]. However, in pregnant women, the HbA1c might be lower than that in healthy controls because 1) pregnant women are younger and the fasting blood glucose increases over age. Thus, relatively older, healthy non-pregnant women may have h Continue reading >>

Associations Of Mid-pregnancy Hba1c With Gestational Diabetes And Risk Of Adverse Pregnancy Outcomes In High-risk Taiwanese Women

Associations Of Mid-pregnancy Hba1c With Gestational Diabetes And Risk Of Adverse Pregnancy Outcomes In High-risk Taiwanese Women

Abstract The objective of this study was to investigate the associations among the mid-pregnancy glycated hemoglobin A1c (HbA1c) level, gestational diabetes (GDM), and risk of adverse pregnancy outcomes in women without overt diabetes and with positive 50-g, 1-h glucose challenge test (GCT) results (140 mg/dL or greater). This prospective study enrolled 1,989 pregnant Taiwanese women. A two-step approach, including a 50-g, 1-h GCT and 100-g, 3-h oral glucose tolerance test (OGTT), was employed for the diagnosis of GDM at weeks 23–32. The mid-pregnancy HbA1c level was measured at the time the OGTT was performed. A receiver operating characteristic (ROC) curve was used to determine the relationship between the mid-pregnancy HbA1c level and GDM. Multiple logistic regression models were implemented to assess the relationships between the mid-pregnancy HbA1c level and adverse pregnancy outcomes. An ROC curve demonstrated that the optimal mid-pregnancy HbA1c cut-off point to predict GDM, as diagnosed by the Carpenter-Coustan criteria using a two-step approach, was 5.7%. The area under the ROC curve of the mid-pregnancy HbA1c level for GDM was 0.70. Compared with the levels of 4.5–4.9%, higher mid-pregnancy HbA1c levels (5.0–5.4, 5.5–5.9, 6.0–6.4, 6.5–6.9, and >7.0%) were significantly associated with increased risks of gestational hypertension or preeclampsia, preterm delivery, admission to the neonatal intensive care unit, low birth weight, and macrosomia (the odds ratio [OR] ranges were 1.20–9.98, 1.31–5.16, 0.88–3.15, 0.89–4.10, and 2.22–27.86, respectively). The mid-pregnancy HbA1c level was associated with various adverse pregnancy outcomes in high-risk Taiwanese women. However, it lacked adequate sensitivity and specificity to replace the two-step Continue reading >>

Diabetes In Pregnancy: Management From Preconception To The Postnatal Period

Diabetes In Pregnancy: Management From Preconception To The Postnatal Period

Testing your blood glucose levels You care team should talk with you about when you should test your blood glucose levels during the day. Diabetes type and treatment When should I test? Women with type 1 diabetes Fasting (before breakfast) Before other meals 1 hour after all meals Bedtime Women with type 2 diabetes or gestational diabetes having 2 or more insulin injections a day Fasting (before breakfast) Before other meals 1 hour after all meals Bedtime Women with type 2 diabetes or gestational diabetes having any of the following: changes to diet and exercise tablets (metformin and/or glibenclamide) 1 insulin injection a day Fasting (before breakfast) 1 hour after all meals You and your care team should agree ideal (or target) blood glucose levels that are right for you and are manageable without causing problems with hypoglycaemia. If you are taking metformin or glibenclamide tablets, or you are on insulin, you should be advised to aim for the following target blood glucose levels, unless this leads to difficulties with hypoglycaemia: If you are not able to test until 2 hours (rather than 1 hour) after a meal, the target glucose level at that time should be below 6.4 mmol/litre. If you are on insulin or glibenclamide, you should also be advised to keep your blood glucose above 4 mmol/litre, because of the risk of hypoglycaemia. An HbA1c test tells you your average blood glucose levels over the last 2 to 3 months. Your care team will review your insulin treatment with you, and may suggest a different type to help you achieve your blood glucose targets. Your care team should explain how being pregnant can make it harder for you to recognise hypoglycaemia, especially in the first 3 months. You should make sure you have fast‑acting forms of glucose, such as sugar‑co Continue reading >>

How To Detect True Gestational Diabetes

How To Detect True Gestational Diabetes

The study showed that 7% of women diagnosed with gestational diabetes were already diabetic at the time of first visit and were misdiagnosed with gestational diabetes, when they had diabetes. They also found that, a HBA1C level at the first visit of less than 5.3 would not develop gestational diabetes during the entire course of pregnancy. HBA1C test can tell if a woman has been a diabetic even before conception. HBA1C test should be done at first visit especially when GTT tests abnormal Women who develop diabetes during pregnancy are said to have gestational diabetes (GDM). But, the way pregnant women are tested for GDM makes it difficult to say with surety that the disease has indeed been developed only during pregnancy. Women who are already diabetic but become aware of their disease at the time of pregnancy cannot be classified as having gestational diabetes. The conventional way to detect GDM is through oral glucose tolerance tests (OGTT). But such testing has a limitation; it cannot tell if the woman is truly a GDM case or a diabetic even prior to conception. Unlike the OGTT, the HBA1C test is equipped to tell if a woman has been a diabetic even before conception. This is because HBA1C provides the average concentration of blood glucose during the weeks previous to testing. So the HBA1C test when done at the time of first visit, especially when the OGTT value is abnormal, can help in distinguishing the true GDM cases from the other. The paper published in the Diabetes Care journal last year by Dr. Balaji and others found that 33 of the 507 women tested had HBA1C above 6. This clearly showed that they (33 women) did not develop diabetes during pregnancy but were already diabetic (even before conception). Detecting women who are diabetic even before conception is ve Continue reading >>

Hba1c Levels Are Significantly Lower In Early And Late Pregnancy

Hba1c Levels Are Significantly Lower In Early And Late Pregnancy

Strict glycemic control is essential to minimize the maternal and fetal morbidity and mortality of pregnancies complicated by diabetes (1–3). In addition to home blood glucose measurement, which may not always reflect the true average blood glucose level (4), HbA1c is a useful parameter in metabolic regulation (5–8). Thus, supplementation with HbA1c, as is common outside pregnancy, seems appropriate. Before pregnancy, the target for metabolic control in women with diabetes is HbA1c values near the normal range (9). However, the upper normal range of HbA1c during normal pregnancy is only sparsely investigated with different methods (10), mainly in late pregnancy (5,6,11,12), and reference ranges are generally established from the nonpregnant state (4). Increased third-trimester HbA1c levels are associated with an increased risk of preeclampsia (3,13), macrosomia (1), and stillbirth (2), leading to speculations that the target for HbA1c in pregnancy should be even lower than outside pregnancy to prevent adverse events. There is a need to establish the reference range of HbA1c during normal pregnancy with an internationally recognized Diabetes Control and Complications Trial (DCCT)-aligned method. In this study, we evaluated the normal upper range of HbA1c in early and late pregnancy. RESEARCH DESIGN AND METHODS From our antenatal clinic, we randomly selected 100 healthy pregnant women without previous gestational diabetes (early pregnancy group). All subjects had a random capillary blood glucose level <7.0 mmol/l at their first antenatal visit at approximately week 14 (range 8–17), and none developed gestational diabetes. A selective screening based on risk factors for gestational diabetes was used (14). A late pregnancy group was established of 98 h Continue reading >>

Pregnancy With Diabetes

Pregnancy With Diabetes

A Doable Challenge Women with Type 1 or Type 2 diabetes who are considering pregnancy have reason to feel optimistic. That’s because women with diabetes can and do experience healthy, uneventful pregnancies and give birth to perfectly healthy babies. That said, however, a pregnancy with preexisting diabetes is always considered high-risk, and its outcome is largely dependent on a woman’s efforts to keep her blood glucose levels as close to the normal range as possible for the entire duration of her pregnancy. The American Diabetes Association recommends blood glucose goals for pregnant women that are lower than those suggested for the general population: 60–99 mg/dl before meals and 100–129 mg/dl one hour after eating. Anyone with diabetes knows that staying in that range every day for nine months requires tremendous commitment, even when not pregnant. Achieving those goals while pregnancy hormones are wreaking havoc with your insulin needs and while your whole body is growing and changing is another thing altogether. Add morning sickness, exhaustion, swollen ankles, and normal pregnancy anticipation into the mix, and you have a full bag of stress triggers. So how does a pregnant woman with diabetes manage to keep herself and her baby healthy while also balancing her usual family, work, and other life responsibilities? This article offers strategies based on experiences from my own two pregnancies as well as those from other women with diabetes who have made the effort to do all that was in their power to bring healthy children into the world. (Note: This article focuses on women with existing Type 1 or 2 diabetes before pregnancy rather than women who develop gestational diabetes during pregnancy). Pregnancy preparation When I first mentioned wanting to have a Continue reading >>

Hba1c And Pregnancy

Hba1c And Pregnancy

Tweet Keeping blood sugar levels under control is hugely important for women who either have diabetes going into pregnancy or who develop diabetes during their pregnancy. Tight blood glucose control helps increase the chances of a successful pregnancy by cutting the risk of complications for your baby. If you have diabetes, one of the ways your doctor or nurse will monitor your glycemic control is by carrying out a HbA1c test. The HbA1c test measures glycated haemoglobin - a molecule within red blood cells that naturally bonds with glucose - to get a good indication of your average blood glucose over the past 8-12 weeks. This guide outlines when your HbA1c readings will be taken and what HbA1c values should be before (planning stage), during and after your pregnancy. Planning pregnancy The NICE guidelines for Diabetes in Pregnancy (Clinical Guideline 63) state that women with diabetes should aim to achieve an HbA1c result of 43 mmol/mol (6.1%) or lower. If you are planning to become pregnant, you should be offered an HbA1c measurement on a monthly basis to help monitor your blood glucose control. Meeting the target will help to minimise the risk of the baby developing risk of congenital malformations. If you have an HbA1c above 10%, it is strongly advised to avoid becoming pregnant until good diabetes control is achieved and sustained. During pregnancy During the first trimester of pregnancy, the HbA1c target for women with diabetes is the same as for planning a pregnancy, that is 43 mmol/mol (6.1%) or lower. During the second and third trimesters of pregnancy, from week 13 onwards, HbA1c should not be used for assessing blood glucose control. Throughout pregnancy, women with diabetes should aim to meet the following blood glucose targets Before meals: 3.5 to 5.9 mmol/l Continue reading >>

Patient Education: Care During Pregnancy For Women With Type 1 Or 2 Diabetes Mellitus (beyond The Basics)

Patient Education: Care During Pregnancy For Women With Type 1 Or 2 Diabetes Mellitus (beyond The Basics)

INTRODUCTION Before insulin became available in 1922, women with diabetes mellitus were at very high risk of complications of pregnancy. Today, most women with diabetes can have a safe pregnancy and delivery, similar to that of women without diabetes. This improvement is largely due to good blood glucose (sugar) control, which requires adherence to diet, frequent daily blood glucose monitoring, and frequent insulin adjustment. This topic review discusses care of women with type 1 or 2 diabetes during pregnancy, as well as fetal and newborn issues. It does not address gestational diabetes, which is diabetes that is first diagnosed during pregnancy. (See "Patient education: Gestational diabetes mellitus (Beyond the Basics)".) IMPORTANCE OF BLOOD GLUCOSE CONTROL Glucose in the mother's blood crosses the placenta to provide energy for the baby; thus, high blood glucose levels in the mother lead to high blood glucose levels in the developing baby as well. High blood glucose levels can cause several problems: Early in pregnancy, high glucose levels increase the risk of miscarriage and birth defects. These risks are highest when glycated hemoglobin (hemoglobin A1C or A1C) is >8 percent or the average blood glucose is >180 mg/dL (10 mmol/L). In the last half of pregnancy and near delivery, high blood glucose levels can cause the baby's size and weight to be larger than average and increase the risk of complications during and after delivery (see 'Newborn issues' below). In particular, women with large babies are more likely to have difficulty with a vaginal birth and have a higher chance of needing a cesarean delivery. In the last half of pregnancy, women with diabetes are more prone to developing pregnancy-induced hypertension (preeclampsia) and an excessive amount of amniotic 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 >>

Ten Things You Need To Know Before You Get Pregnant If You Have Diabetes

Ten Things You Need To Know Before You Get Pregnant If You Have Diabetes

10/07/2015 16:57 BST | Updated 10/07/2016 10:59 BST Ten Things You Need to Know Before You Get Pregnant if You Have Diabetes Suzi Godson The Times sex columnist and editor of www.suzigodson.com 1. Pregnancy can be a challenge for any woman, but for women suffering from diabetes, it presents a very particular set of problems. There are two different forms of diabetes; Type 1, which is relatively rare, and Type 2 which accounts for 90% of all diabetes. Both forms of diabetes interfere with the bodies ability to regulate blood sugar levels and this can cause serious complications for women who want to have children. 2. High blood sugars quadruple the risk of birth defects, so it is essential for women with diabetes to have good blood sugar control for at least three months before they get pregnant. Despite the need for careful pre-pregnancy diabetes planning, the Confidential Enquiry into Maternal and Child Health Diabetes Programme (CEMACH) which was set up to provide an overview of diabetes maternity services, national pregnancy outcome rates and standards of care, found that between 2002 and 2003, fewer than half (41%) of women with diabetes studied in the enquiry had planned their pregnancy. This compared to a planned pregnancy rate of 58% in the general maternity population in 2001-02. 3. Evidence for the positive impact of good glucose control on perinatal outcome has been available since the 1980s, but the CEMACH enquiry also found that the majority of diabetic women entered pregnancy with poor blood sugar control. 4. Women suffering from diabetes are advised to have regular HbA1c testing prior to getting pregnant in order to reduce the risk of adverse outcomes. HbA1c testing measures the amount of glucose-bound haemoglobin and reflects how well blood sugar levels Continue reading >>

What Are The Target Blood Sugar Levels During The Second And Third Trimester Of Pregnancy For Women With Type 1 Diabetes?

What Are The Target Blood Sugar Levels During The Second And Third Trimester Of Pregnancy For Women With Type 1 Diabetes?

This study investigated blood glucose control in the second and third trimesters and pregnancy outcomes in women with type 1 diabetes. The authors concluded that regular testing of average blood glucose levels could be beneficial, as higher levels were associated with adverse outcomes. Patients with type 1 diabetes (T1D) do produce enough insulin (the hormone needed to break down the glucose taken in from food. During pregnancy, women with uncontrolled blood sugar levels are at a higher risk of adverse outcomes for both mother and baby. Larger newborn size is one possible outcome. Excessively large babies, for example, can have an increased risk of obesity and diabetes. It is currently recommended that women try to achieve HbA1c levels (average blood glucose over 3 months) under 6% during the first trimester. It is not clear whether this should be the same target in the second or third trimesters. This study included 725 pregnant women with T1D. HbA1c levels were measured at 26 and 34 weeks. Patients were followed to determine the outcomes of both the mother and the baby following birth. At 26 weeks of pregnancy, patients with an HbA1c between 6.0% and 6.4% were 70% more likely to have babies who were large at birth. Patients with levels between 6.5 and 6.9% at 26 weeks were over twice as likely to give birth prematurely, to have a baby requiring sugar infusion at birth, or a combination of other adverse outcomes. These results were similar forHbA1c at 34 weeks. This study concluded that higher HbA1c levels during the second and third trimesters were associated with an increased risk of adverse outcomes. The authors suggested that it was worthwhile for women with T1D to undergo regular HbA1c measurements. Patients must balance their blood sugar control with the preventi Continue reading >>

More in diabetes