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Who Criteria For Diagnosing Diabetes In Pregnancy?

Diagnosis

Diagnosis

Print Medical experts haven't agreed on a single set of screening guidelines for gestational diabetes. Some question whether gestational diabetes screening is needed if you're younger than 25 and have no risk factors. Others say that screening all pregnant women is the best way to identify all cases of gestational diabetes. When to screen Your doctor will likely evaluate your risk factors for gestational diabetes early in your pregnancy. If you're at high risk of gestational diabetes — for example, your body mass index (BMI) before pregnancy was 30 or higher or you have a mother, father, sibling or child with diabetes — your doctor may test for diabetes at your first prenatal visit. If you're at average risk of gestational diabetes, you'll likely have a screening test during your second trimester — between 24 and 28 weeks of pregnancy. Routine screening for gestational diabetes Initial glucose challenge test. You'll drink a syrupy glucose solution. One hour later, you'll have a blood test to measure your blood sugar level. A blood sugar level below 130 to 140 milligrams per deciliter (mg/dL), or 7.2 to 7.8 millimoles per liter (mmol/L), is usually considered normal on a glucose challenge test, although this may vary by clinic or lab. If your blood sugar level is higher than normal, it only means you have a higher risk of gestational diabetes. You'll need a glucose tolerance test to determine if you have the condition. Follow-up glucose tolerance testing. You'll fast overnight, then have your blood sugar level measured. Then you'll drink another sweet solution — this one containing a higher concentration of glucose — and your blood sugar level will be checked every hour for three hours. If at least two of the blood sugar readings are higher than normal, you'll Continue reading >>

Screening And Diagnosis Of Gestational Diabetes Mellitus – Relevance To Low And Middle Income Countries

Screening And Diagnosis Of Gestational Diabetes Mellitus – Relevance To Low And Middle Income Countries

Abstract Gestational diabetes mellitus (GDM) is one of the most common metabolic complications of pregnancy. Ever since the first systematic evaluation of the oral glucose tolerance test by O’Sullivan and colleagues was carried out in 1964, there has been controversy with respect to the optimal screening and diagnostic criteria to detect GDM. The recently proposed International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for GDM has found fairly widespread acceptance, but it is still debated by several societies. This review intends to provide an overview of the evolution of the screening and diagnostic criteria for GDM. Debatable issues regarding optimal screening strategies, especially in the low resource settings of low and middle income countries are highlighted. The recent Women in India with GDM Strategy (WINGS) project carried out in Chennai, India tried to develop a Model of Care for GDM suitable for resource constrained settings. The findings related to screening and diagnosis of GDM based on WINGS are also highlighted in this review. Based on the WINGS experience we believe that despite the constraints in low and middle income countries at the present time, the IADPSG criteria appears to be the best. This will also help to bring out a uniform criteria for screening and diagnosis of GDM worldwide. Background The criteria for diagnosing diabetes outside of pregnancy, has evolved over time and have been largely accepted by major diabetes organizations worldwide. However, the screening and diagnosis of gestational diabetes mellitus (GDM) continues to be a contentious issue. Notwithstanding decades of research and several international workshops devoted to GDM, there is still no consensus among international bodies on a uniform global app Continue reading >>

New Thresholds For Diagnosis Of Diabetes In Pregnancy

New Thresholds For Diagnosis Of Diabetes In Pregnancy

Share Midwives should diagnose women with gestational diabetes if they either have a fasting plasma glucose level of 5.6 mmol/litre or above, or a 2-hour plasma glucose level of 7.8 mmol/litre or above, according to NICE. Midwives should diagnose women with gestational diabetes if they either have a fasting plasma glucose level of 5.6 mmol/litre or above, or a 2-hour plasma glucose level of 7.8 mmol/litre or above, according to NICE. Updated guidelines on diabetes in pregnancy lower the fasting plasma glucose thresholds for diagnosis, and include new recommendations on self-management for women with type 1 diabetes. Around 35,000 women have either pre-existing or gestational diabetes each year in England and Wales. Nearly 90 per cent of the women who have diabetes during pregnancy, have gestational diabetes, which may or may not resolve after pregnancy. Rates have increased in recent years to due rising obesity rates among the general population, and increasing number of pregnancies among older women. Of the women with diabetes in pregnancy who do not have gestational diabetes, 7.5 per cent of women have type 1 diabetes, and the remainder have type 2 diabetes, both of which have also increased recently. Following a number of developments, such as new technologies and research on diagnosis and treatment of gestational diabetes, NICE has updated its guidelines on diabetes in pregnancy. Diagnosis Among the new recommendations are that a woman should be diagnosed with gestational diabetes if she has either a fasting plasma glucose level of 5.6 mmol/litre or above, or a 2-hour plasma glucose level of 7.8 mmol/litre or above. NICE says this could help tackle current variation in the number in the glucose levels used for diagnosing gestational diabetes, and may lead to an incr Continue reading >>

Diagnosis And Management Of Gestational Diabetes Mellitus

Diagnosis And Management Of Gestational Diabetes Mellitus

Gestational diabetes occurs in 5 to 9 percent of pregnancies in the United States and is growing in prevalence. It is a controversial entity, with conflicting guidelines and treatment protocols. Recent studies show that diagnosis and management of this disorder have beneficial effects on maternal and neonatal outcomes, including reduced rates of shoulder dystocia, fractures, nerve palsies, and neonatal hypoglycemia. Diagnosis is made using a sequential model of universal screening with a 50-g one-hour glucose challenge test, followed by a diagnostic 100-g three-hour oral glucose tolerance test for women with a positive screening test. Treatment consists of glucose monitoring, dietary modification, exercise, and, when necessary, pharmacotherapy to maintain euglycemia. Insulin therapy is the mainstay of treatment, although glyburide and metformin may become more widely used. In women receiving pharmacotherapy, antenatal testing with nonstress tests and amniotic fluid indices beginning in the third trimester is generally used to monitor fetal well-being. The method and timing of delivery are controversial. Women with gestational diabetes are at high risk of subsequent development of type 2 diabetes. Lifestyle modification should therefore be encouraged, along with regular screening for diabetes. Evidence for screening, diagnosing, and managing gestational diabetes mellitus has continued to accrue over the past several years. In 2003, the U.S. Preventive Services Task Force1 (USPSTF) and the Cochrane Collaboration2 found insufficient evidence to recommend for or against screening for or treating gestational diabetes. However, a subsequent randomized controlled trial (RCT) found that screening and intervention for gestational diabetes were beneficial.3 Nonetheless, in 2008, Continue reading >>

Gestational Diabetes

Gestational Diabetes

Gestational diabetes is high blood sugar that develops during pregnancy and usually disappears after giving birth. It can occur at any stage of pregnancy, but is more common in the second half. It occurs if your body cannot produce enough insulin – a hormone that helps control blood sugar levels – to meet the extra needs in pregnancy. Gestational diabetes can cause problems for you and your baby during and after birth. But the risk of these problems happening can be reduced if it's detected and well managed. Who's at risk of gestational diabetes Any woman can develop gestational diabetes during pregnancy, but you're at an increased risk if: your body mass index (BMI) is above 30 – use the healthy weight calculator to work out your BMI you previously had a baby who weighed 4.5kg (10lbs) or more at birth you had gestational diabetes in a previous pregnancy one of your parents or siblings has diabetes your family origins are south Asian, Chinese, African-Caribbean or Middle Eastern If any of these apply to you, you should be offered screening for gestational diabetes during your pregnancy. Symptoms of gestational diabetes Gestational diabetes doesn't usually cause any symptoms. Most cases are only picked up when your blood sugar level is tested during screening for gestational diabetes. Some women may develop symptoms if their blood sugar level gets too high (hyperglycaemia), such as: But some of these symptoms are common during pregnancy anyway and aren't necessarily a sign of a problem. Speak to your midwife or doctor if you're worried about any symptoms you're experiencing. How gestational diabetes can affect your pregnancy Most women with gestational diabetes have otherwise normal pregnancies with healthy babies. However, gestational diabetes can cause problems s Continue reading >>

Screening And Diagnosis Of Gestational Diabetes Mellitus, Where Do We Stand

Screening And Diagnosis Of Gestational Diabetes Mellitus, Where Do We Stand

Go to: Any degree of glucose intolerance with the onset or first recognition during pregnancy is defined as Gestational Diabetes Mellitus (GDM) [1]. Women with history of GDM are at an increased risk of adverse maternal and perinatal outcome and also at increased risk of future diabetes predominantly Type II including their children and therefore there are two generations at risk [2]. Any degree of glucose intolerance during pregnancy is associated with adverse maternal and fetal outcome. The adverse maternal complications include hypertension, preeclampsia, urinary tract infection, hydramnios, increased operative intervention and future DM. In the fetus and neonates it is associated with macrosomia, congenital anomalies, metabolic abnormalities, RDS, etc. and subsequent childhood and adolescent obesity [3]. Therefore, it is important to diagnose early and treat promptly to prevent complications. GDM is a topic of considerable controversy when it comes to its screening, diagnosis and its cost-effectiveness. Precise level of glucose intolerance characterizing GDM has been controversial over three decades. High prevalence of DM and genetic predisposition to metabolic syndrome among Asians, particularly in Indian women, predisposes women to develop GDM and its complications. So, there is a need for cost-effective universal screening and diagnostic method. Unfortunately there is no international consensus on the screening and diagnostic criteria for GDM. The rationale of this review is to provide recent updates and to discuss the controversies of screening and diagnosis of GDM. It affects 7% of all pregnancies worldwide and in India it ranges from 6 to 9% in rural and 12 to 21% in urban area [4]. The high rate implies that Indian population has a higher incidence of DM and Continue reading >>

Gestational Diabetes Mellitus

Gestational Diabetes Mellitus

DEFINITION, DETECTION, AND DIAGNOSIS Definition Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy (1). The definition applies whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy. It does not exclude the possibility that unrecognized glucose intolerance may have antedated or begun concomitantly with the pregnancy. Approximately 7% of all pregnancies are complicated by GDM, resulting in more than 200,000 cases annually. The prevalence may range from 1 to 14% of all pregnancies, depending on the population studied and the diagnostic tests employed. Detection and diagnosis Risk assessment for GDM should be undertaken at the first prenatal visit. Women with clinical characteristics consistent with a high risk of GDM (marked obesity, personal history of GDM, glycosuria, or a strong family history of diabetes) should undergo glucose testing (see below) as soon as feasible. If they are found not to have GDM at that initial screening, they should be retested between 24 and 28 weeks of gestation. Women of average risk should have testing undertaken at 24–28 weeks of gestation. Low-risk status requires no glucose testing, but this category is limited to those women meeting all of the following characteristics: Weight normal before pregnancy Member of an ethnic group with a low prevalence of GDM No known diabetes in first-degree relatives No history of abnormal glucose tolerance No history of poor obstetric outcome A fasting plasma glucose level >126 mg/dl (7.0 mmol/l) or a casual plasma glucose >200 mg/dl (11.1 mmol/l) meets the threshold for the diagnosis of diabetes, if confirmed on a subsequent day, and precludes the need for Continue reading >>

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 >>

Pregnancydm S2 Screening

Pregnancydm S2 Screening

Identification, Screening, and Diagnosis of Diabetes in Pregnancy GDM Definition, Etiology, Risk Factors, and Pathophysiology Gestational diabetes mellitus (GDM) has been defined as any degree of carbohydrate intolerance with onset during pregnancy. This definition is a misnomer in that it includes unrecognized overt diabetes that may have been present prior to pregnancy as well as hyperglycemia that develops during pregnancy. Preexisting type 2 diabetes can often present as severe hyperglycemia during pregnancy. GDM is due to hormonally induced insulin resistance, which leads to hyperglycemia and eventually diabetes. The following are risk factors for GDM:1,2 Family history of diabetes in a first-degree relative During pregnancy, insulin resistance develops as a normal response to the placental secretion of anti-insulin hormones, such as cortisol, growth hormone, human placental lactogen, progesterone, and tumor necrosis factor alpha (TNF-).3 In late pregnancy, to meet the glycemic demands of the growing fetus, maternal hepatic glucose production increases by 15% to 30%.3 In some patients, pancreatic beta-cell dysfunction develops, and the level of insulin secretion becomes insufficient to maintain glucose homeostasis. Multiple factors may contribute to the onset of beta-cell failure, including genetics, autoimmune disorders, and chronic insulin resistance.4 The onset of GDM occurs as a result of the combined effects of glucose intolerance, hyperglycemia, and beta-cell dysfunction.3,4 Diabetes Diagnosed During Pregnancy: GDM Screening guidelinespregnancy and postpartum: According to 2011 guidelines published by both AACE and the American Diabetes Association (ADA), GDM screening should be performed in all pregnant women at 24 to 28 weeks gestation.2,5 In addition, the Continue reading >>

Gestational Diabetes

Gestational Diabetes

Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy.[2] Gestational diabetes generally results in few symptoms;[2] however, it does increase the risk of pre-eclampsia, depression, and requiring a Caesarean section.[2] Babies born to mothers with poorly treated gestational diabetes are at increased risk of being too large, having low blood sugar after birth, and jaundice.[2] If untreated, it can also result in a stillbirth.[2] Long term, children are at higher risk of being overweight and developing type 2 diabetes.[2] Gestational diabetes is caused by not enough insulin in the setting of insulin resistance.[2] Risk factors include being overweight, previously having gestational diabetes, a family history of type 2 diabetes, and having polycystic ovarian syndrome.[2] Diagnosis is by blood tests.[2] For those at normal risk screening is recommended between 24 and 28 weeks gestation.[2][3] For those at high risk testing may occur at the first prenatal visit.[2] Prevention is by maintaining a healthy weight and exercising before pregnancy.[2] Gestational diabetes is a treated with a diabetic diet, exercise, and possibly insulin injections.[2] Most women are able to manage their blood sugar with a diet and exercise.[3] Blood sugar testing among those who are affected is often recommended four times a day.[3] Breastfeeding is recommended as soon as possible after birth.[2] Gestational diabetes affects 3–9% of pregnancies, depending on the population studied.[3] It is especially common during the last three months of pregnancy.[2] It affects 1% of those under the age of 20 and 13% of those over the age of 44.[3] A number of ethnic groups including Asians, American Indians, Indigenous Australians, and Pacific Continue reading >>

Gestational Diabetes

Gestational Diabetes

Gestational diabetes definition and facts Risk factors for gestational diabetes include a history of gestational diabetes in a previous pregnancy, There are typically no noticeable signs or symptoms associated with gestational diabetes. Gestational diabetes can cause the fetus to be larger than normal. Delivery of the baby may be more complicated as a result. The baby is also at risk for developing low blood glucose (hypoglycemia) immediately after birth. Following a nutrition plan is the typical treatment for gestational diabetes. Maintaining a healthy weight and following a healthy eating plan may be able to help prevent or minimize the risks of gestational diabetes. Women with gestational diabetes have an increased risk of developing type 2 diabetes after the pregnancy What is gestational diabetes? Gestational diabetes is diabetes, or high blood sugar levels, that develops during pregnancy. It occurs in about 4% of all pregnancies. It is usually diagnosed in the later stages of pregnancy and often occurs in women who have no prior history of diabetes. What causes gestational diabetes? Gestational diabetes is thought to arise because the many changes, hormonal and otherwise, that occur in the body during pregnancy predispose some women to become resistant to insulin. Insulin is a hormone made by specialized cells in the pancreas that allows the body to effectively metabolize glucose for later usage as fuel (energy). When levels of insulin are low, or the body cannot effectively use insulin (i.e., insulin resistance), blood glucose levels rise. What are the screening guidelines for gestational diabetes? All pregnant women should be screened for gestational diabetes during their pregnancy. Most pregnant women are tested between the 24th and 28th weeks of pregnancy (see Continue reading >>

Criteria For Diagnosing Diabetes - Topic Overview

Criteria For Diagnosing Diabetes - Topic Overview

To be diagnosed with diabetes, you must meet one of the following criteria:1 Have symptoms of diabetes (increased thirst, increased urination, and unexplained weight loss) and a blood sugar level equal to or greater than 200 milligrams per deciliter (mg/dL). The blood sugar test is done at any time, without regard for when you last ate (random plasma glucose test or random blood sugar test). Have a fasting blood sugar level that is equal to or greater than 126 mg/dL. A fasting blood sugar test (fasting plasma glucose) is done after not eating or drinking anything but water for 8 hours. Have a 2-hour oral glucose tolerance test (OGTT) result that is equal to or greater than 200 mg/dL. An OGTT is most commonly done to check for diabetes that occurs with pregnancy (gestational diabetes). Have a hemoglobin A1c that is 6.5% or higher. Your doctor may repeat the test to confirm the diagnosis of diabetes. If the results of your fasting blood sugar test are between 100 mg/dL and 125 mg/dL, your OGTT result is between 140 to 199 mg/dL (2 hours after the beginning of the test), or your hemoglobin A1c is 5.7% to 6.4%, you have prediabetes. This means that your blood sugar is above normal but not high enough to be diabetes. Discuss with your doctor how often you need to be tested.1 Continue reading >>

Screening And Diagnosis Of Gestational Diabetes Mellitus

Screening And Diagnosis Of Gestational Diabetes Mellitus

Screening and Diagnosis of Gestational Diabetes Mellitus Diabetes and pregnancy: an Endocrine Society clinical practice guideline. U.S. Preventive Services Task Force (USPSTF) Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Internet citation: National Guideline Clearinghouse (NGC). Guideline synthesis: Screening and diagnosis of gestational diabetes. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2014 May (revised 2017 July). [cited YYYY Mon DD]. Available: A direct comparison of recommendations presented in the above guidelines for the detection and diagnosis of GDM in pregnant women not previously diagnosed with type 1 or 2 diabetes mellitus is provided below. Treatment of GDM is beyond the scope of this synthesis. TES and the USPSTF agree that pregnant women should be screened for GDM at 2428 weeks gestation. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for GDM in asymptomatic pregnant women before 24 weeks of gestation. When deciding whether to screen for GDM before 24 weeks of gestation, the USPSTF addresses factors that should be considered by primary care providers. Historically, GDM has been diagnosed in the United States using a two-step approach: administration of a 50-gram oral glucose solution followed by a 1-hour venous glucose determination. Individuals meeting or exceeding the screening threshold then undergo a 100-g, 3-hour diagnostic OGTT, given while the patient is fasting. In a divergence from established U.S. practice, TES recommends a one-step approach to screening using a 2-hour, 75-g OGTT. TES further recommends that the IADPSG criteria be u Continue reading >>

Gestational Diabetes

Gestational Diabetes

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 only with gestational diabetes. There is a separate Diabetes in Pregnancy article, which provides information about pregnancy in women with pre-existing diabetes. Gestational diabetes mellitus (GDM) is any degree of glucose intolerance with its onset (or first diagnosis) during pregnancy and usually resolving shortly after delivery[1]. Pregnancy hormones decrease fasting glucose levels, increase fat deposition, delay gastric emptying and increase appetite. However, over the course of pregnancy, postprandial glucose concentrations increase as insulin resistance increases. This is normally countered by an increased production of insulin but in women with GDM there is an insufficient compensatory rise[2]. There is no clear agreement on diagnostic criteria[3]. Pregnancy hyperglycaemia without meeting GDM diagnostic criteria affects a significant proportion of pregnant women each year and is associated with a range of adverse pregnancy outcomes[4]. The National Institute for Health and Care Excellence (NICE) recommends that GDM should be diagnosed if the pregnant woman has either[5]: Fasting plasma glucose level of 5.6 mmol/L or above; or Two-hour plasma glucose level of 7.8 mmol/L or above. Although the World Health Organization (WHO) now recommends that HbA1c can be used as a diagnostic test for diabetes, it is currently not recommended for diagnosis during pregnancy[6]. Many of the problems associated with GDM are common to established diabetes in pregnancy - hype 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 >>

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