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Who Criteria For Diagnosing Diabetes In Pregnancy?

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 >>

Trends In The Diagnosis Of Gestational Diabetes Mellitus

Trends In The Diagnosis Of Gestational Diabetes Mellitus

Copyright © 2016 Surabhi Mishra et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable degree with onset or recognition during pregnancy. As prevalence of diabetes is linked to impaired glucose tolerance during antenatal period, routine antenatal screening of GDM is required. However, screening tests for GDM remain controversial. Objective. To review different diagnostic criteria for GDM. Materials and Methods. Freely accessible, full-text articles from 1964 to 2015, available in PubMed in English language, pertaining to screening of GDM were reviewed. Results. First diagnostic criteria for GDM in 1964 by O’Sullivan and Mahan, modified by the National Diabetes Data Group (NDDG) in 1979 and Carpenter in 1982. The cut-off value as per WHO definition of GDM was 140 mg/dL, 2 hours after 75 g glucose intake. Diabetes in Pregnancy Study Group India (DIPSI), in 2006, endorsed WHO criteria but irrespective of the last meal timings. Being cost-effective, it formed the basis of national guidelines for Indians in 2014. Conclusions. As typical clinical scenarios are usually varied, practical guidelines that meet the constraints of low-resource settings like India are required. 1. Introduction Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable degree with onset or recognition during pregnancy. As per the International Diabetes Federation (IDF), Diabetes Atlas 2015, one in seven births are affected by GDM [1]. India, being the second leading dweller of diabetic subjects (69.2 millio 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 >>

2. Classification And Diagnosis Of Diabetes

2. Classification And Diagnosis Of Diabetes

Classification Diabetes can be classified into the following general categories: Type 1 diabetes (due to β-cell destruction, usually leading to absolute insulin deficiency) Type 2 diabetes (due to a progressive loss of insulin secretion on the background of insulin resistance) Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes) Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young [MODY]), diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes (such as with glucocorticoid use, in the treatment of HIV/AIDS or after organ transplantation) This section reviews most common forms of diabetes but is not comprehensive. For additional information, see the American Diabetes Association (ADA) position statement “Diagnosis and Classification of Diabetes Mellitus” (1). Type 1 diabetes and type 2 diabetes are heterogeneous diseases in which clinical presentation and disease progression may vary considerably. Classification is important for determining therapy, but some individuals cannot be clearly classified as having type 1 or type 2 diabetes at the time of diagnosis. The traditional paradigms of type 2 diabetes occurring only in adults and type 1 diabetes only in children are no longer accurate, as both diseases occur in both cohorts. Occasionally, patients with type 2 diabetes may present with diabetic ketoacidosis (DKA). Children with type 1 diabetes typically present with the hallmark symptoms of polyuria/polydipsia and approximately one-third with DKA (2). The onset of type 1 diabetes may be more variable in adults, and they may not present with t 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 >>

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 >>

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 >>

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 >>

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 >>

Updated Guidelines On Screening For Gestational Diabetes

Updated Guidelines On Screening For Gestational Diabetes

1Department of Medicine, Government Medical College and Hospital, Chandigarh, India; 2Bharti Hospital, Karnal, Haryana, India; 3Excel Center, Guwahati, Assam, India; 4Saket City Hospital, New Delhi, India Abstract: Gestational diabetes mellitus (GDM) is associated with an increased risk of complications for both mother and baby during pregnancy as well as in the postpartum period. Screening and identifying these high-risk women is important to improve short- and long-term maternal and fetal outcomes. However, there is a lack of international uniformity in the approach to the screening and diagnosis of GDM. The main purpose of this review is to provide an update on screening for GDM and overt diabetes during pregnancy, and discuss the controversies in this field. We take on debatable issues such as adoption of the new International association of diabetes and pregnancy study groups criteria instead of the Carpenter and Coustan criteria, one-step versus two-step screening, universal screening versus high-risk screening before 24 weeks of gestation for overt diabetes, and, finally, the role of HbA1c as a screening test of GDM. This discussion is followed by a review of recommendations by professional bodies. Certain clinical situations, in which a pragmatic approach is needed, are highlighted to provide a comprehensive overview of the subject. Keywords: pregnancy, guidelines, IADPSG, GDM, Carpenter and Coustan criteria Gestational diabetes mellitus (GDM) has classically been defined as any glucose intolerance first identified during pregnancy.1 Recently, the American Diabetes Association (ADA) defined it as “Diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes”.2 However, as per IADPSG (International association of diabete 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 >>

Screening, Diagnosis, And Management Of Gestational Diabetes Mellitus

Screening, Diagnosis, And Management Of Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) affects approximately 6% of pregnancies in the United States, and it is increasing in prevalence. Pregnant women without known diabetes mellitus should be screened for GDM after 24 weeks of gestation. Treatment of GDM results in a statistically significant decrease in the incidence of preeclampsia, shoulder dystocia, and macrosomia. Initial management includes glucose monitoring and lifestyle modifications. If glucose levels remain above target values, pharmacologic therapy with metformin, glyburide, or insulin should begin. Antenatal testing is customary for women requiring medications. Induction of labor should not occur before 39 weeks in women with GDM, unless glycemic control is poor or another indication for delivery is present. Unless otherwise indicated, scheduled cesarean delivery should be considered only in women with an estimated fetal weight greater than 4,500 g. Women with a history of GDM are at high risk of subsequently developing diabetes. These patients should be screened six to 12 weeks postpartum for persistently abnormal glucose metabolism, and should undergo screening for diabetes every three years thereafter. Gestational diabetes mellitus (GDM) is a condition of glucose intolerance with onset or first recognition in pregnancy that is not clearly overt diabetes.1,2 Normal pregnancy is characterized by pancreatic β-cell hyperplasia resulting in higher fasting and postprandial insulin levels. Increased secretion of placental hormones leads to increasing insulin resistance, especially throughout the third trimester. GDM occurs when β-cell function is insufficient to overcome this insulin resistance.3 Clinical recommendation Evidence rating References Comments Screening for GDM should occur after 24 weeks of gestat Continue reading >>

Diabetes In Pregnancy

Diabetes In Pregnancy

Executive summary iv Key priorities for implementation iv Scope and purpose of the guideline 1 Purpose 1 Definitions for terms used in this guideline 1 The need for the guideline 2 Scope of the guideline 2 Target audience 2 Treaty of Waitangi 2 Guideline development process 3 Funding of the guideline 3 Summary of recommendations 4 1 Screening for probable undiagnosed diabetes in early pregnancy using HbA1c 4 2 Diagnosis of gestational diabetes at 24–28 weeks 5 3 Prevention of gestational diabetes 7 4 Treatment of women with gestational diabetes 8 5 Timing and mode of birth 10 6 Immediate postpartum care 11 7 Information and follow-up 12 8 Postpartum screening 13 9 Gestational diabetes and risk of type 2 diabetes 15 References 16 Continue reading >>

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 >>

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 >>

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