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Who Criteria For Diagnosing Diabetes In Pregnancy?

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 >>

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 >>

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 >>

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 >>

Impact Of Risk Factors And More Stringent Diagnostic Criteria Of Gestational Diabetes On Outcomes In Central European Women | The Journal Of Clinical Endocrinology & Metabolism | Oxford Academic

Impact Of Risk Factors And More Stringent Diagnostic Criteria Of Gestational Diabetes On Outcomes In Central European Women | The Journal Of Clinical Endocrinology & Metabolism | Oxford Academic

Objectives: In the face of the ongoing discussion on the criteria for the diagnosis of gestational diabetes (GDM), we aimed to examine whether the criteria of the Fourth International Workshop Conference of GDM (WC) select women and children at risk better than the World Health Organization (WHO) criteria. Design and Setting: This was a prospective longitudinal open study in five tertiary care centers in Austria. Patients and Outcome Measures: The impact of risk factors, different thresholds (WC vs. WHO), and numbers of abnormal glucose values (WC) during the 2-h, 75-g oral glucose tolerance test on fetal/neonatal complications and maternal postpartum glucose tolerance was studied in 1466 pregnant women. Women were treated if at least one value according to the WC (GDM-WC1) was met or exceeded. Results: Forty-six percent of all women had GDM-WC1, whereas 29% had GDM-WHO, and 21% of all women had two or three abnormal values according to WC criteria (GDM-WC2). Eighty-five percent of the GDM-WHO were also identified by GDM-WC1. Previous GDM [odds ratio (OR) 2.9], glucosuria (OR 2.4), preconceptual overweight/obesity (OR 2.3), age 30 yr or older (OR 1.9), and large-for-gestational age (LGA) fetus (OR 1.8) were the best independent predictors of the occurrence of GDM. Previous GDM (OR 4.4) and overweight/obesity (OR 4.0) also independently predicted diabetes postpartum. GDM-WC1 had a higher rate of obstetrical complications (LGA neonates, neonatal hypoglycemia, cesarean sections; P < 0.001) and impaired postpartum glucose tolerance (P < 0.0001) than GDM-WHO. Conclusion: These results suggest the use of more stringent WC criteria for the diagnosis of GDM with the initiation of therapy in case of one fasting or stimulated abnormal glucose value because these criteria detecte 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 >>

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 >>

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 >>

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 >>

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 >>

Japi - Dipsi Guidelines

Japi - Dipsi Guidelines

Abstract The Diabetes In Pregnancy Study group India (DIPSI) is reporting practice guidelines for GDM in the Indianenvironment. Due to high prevalence, screening is essential for all Indian pregnant women. DIPSI recommendsthat as a pregnant woman walks into the antenatal clinic in the fasting state, she has to be given a 75g oralglucose load and at 2 hrs a venous blood sample is collected for estimating plasma glucose. This one stepprocedure of challenging women with 75 gm glucose and diagnosing GDM is simple, economical and feasible.Screening is recommended between 24 and 28 weeks of gestation and the diagnostic criteria of ADA areapplicable. A team approach is ideal for managing women with GDM. The team would usually comprise anobstetrician, diabetes physician, a diabetes educator, dietitian, midwife and pediatrician. Intensive monitoring,diet and insulin is the corner stone of GDM management. Oral agents or analogues though used are stillcontroversial. Until there is evidence to absolutely prove that ignoring maternal hyperglycemia when thefetal growth patterns appear normal on the ultrasonogram, it is prudent to achieve and maintainnormoglycemia in every pregnancy complicated by gestational diabetes. The maternal health and fetal outcomedepends upon the care by the committed team of diabetologists, obstetricians and neonatologists. A shortterm intensive care gives a long term pay off in the primary prevention of obesity, IGT and diabetes in theoffspring, as the preventive medicine starts before birth. © INTRODUCTION The maternal metabolic adaptation is to maintain themean fasting plasma glucose of 74.5 ± 11 mg/dl andthe post prandial peak of 108.7 ± 16.9mg/dl.1 This fine tuning of glycemic level during pregnancy is possibledue to the compensatory hyperinsulinaemi 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 >>

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 >>

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 >>

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