Pre-gestational Diabetes: A Public Health Growth Industry
Evan Klass, MD, FACP Associate Dean, Statewide Initiatives Director, Project ECHO-Nevada Goals for today 1) Recognize the importance of pre-gestational Diabetes and its magnitude 2) Understand the difference between pre- gestational and gestational Diabetes and the implications of each 3) Consider opportunities for intervention to reduce the health impact of pre-gestational Diabetes I have no financial conflicts to report Definitions Gestational Diabetes (GDM)-Diabetes not detected before pregnancy but discovered during pregnancy. Nearly all (but not all)cases are Type 2 Diabetes Pre-gestational Diabetes (PGDM)- Diabetes diagnosed before conception. Includes women with Type 1 and Type 2 Diabetes How big a problem is this? Women of child bearing age= 63M Prevalence of know Type 1 DM= 1% 630K women Prevalence of known Type 2 DM= 2.9% 1.8M women Prevalence of unknown Type 2 DM= 0.5% 314K women SO: 2.7 million women with preconception Diabetes! Risk of birth defects associated with pregestational diabetes Reviewed all pregnancies in Emilia-Romagna region between 1997-2010 Malformations in 62/2269 diabetic pregnancies vs. 162/10,648 non-diabetic (1:5 cases/controls) Prevalence ratio of 1.79 (controls were age-matched) Prevalence ratio was 0.94 for probable type 1 patients and 4.89 for probable type 2 patients Vinceti M et al. Risk of birth defects associated with maternal pregestational diabetes. Eur J Epidemiol 29:411-18 Risk of major congenital anomalies 3% of all births- leading cause of infant mortality 5.7% of offspring of women with type 1 DM (Norwegian study) 6.6% of offspring of women with type 2DM (British study) Relative risk (RR) for major congenital abnormalities from 14 studies of women with diabetes mellitus who did or did not receive preconception care (PCC). Continue reading >>
Reference
This purpose of this talk is to overview the 2017 American Diabetes Association Standards of Medical Care in Diabetes. These Standards comprise all of the current and key clinical practice recommendations of the American Diabetes Association. [SLIDE] 2 Reference American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care 2014;37(suppl 1):S1 A few notes on the Standards of Care: The Association funds development of the Standards of Care and all Association position statements out of its general revenues and does not use industry support for these purposes [CLICK] The slides are organized to correspond with sections within the 2017 Standards of Care. As we go through I’ll make note of where we are within the document. [CLICK] Though not every section in the document is represented, these slides do incorporate the most salient points from the Position Statement As with all Association position statements, the Standards of Care are reviewed and approved by the Association’s Board of Directors, which includes health care professionals, scientists, and lay people. [SLIDE] 3 These Standards of Care are revised annually by the ADA’s multidisciplinary Professional Practice Committee (PPC) [CLICK] For the 2017 revision, PPC members systematically searched Medline for human studies related to each subsection and published since 1 January 2016. [CLICK] Recommendations were revised based on new evidence or, in some cases, to clarify the prior recommendations or match the strength of the word to the strength of the evidence [CLICK] A table linking the changes in the recommendations to new evidence can be reviewed at professional.diabetes.org/SOC (Standards of Care) [CLICK] The Association and the Professional Practice Committee Continue reading >>
Gestational Diabetes Mellitus Can Be Prevented By Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (radiel)
OBJECTIVE To assess whether gestational diabetes mellitus (GDM) can be prevented by a moderate lifestyle intervention in pregnant women who are at high risk for the disease. RESEARCH DESIGN AND METHODS Two hundred ninety-three women with a history of GDM and/or a prepregnancy BMI of ≥30 kg/m2 were enrolled in the study at <20 weeks of gestation and were randomly allocated to the intervention group (n = 155) or the control group (n = 138). Each subject in the intervention group received individualized counseling on diet, physical activity, and weight control from trained study nurses, and had one group meeting with a dietitian. The control group received standard antenatal care. The diagnosis of GDM was based on a 75-g, 2-h oral glucose tolerance test at 24–28 weeks of gestation. RESULTS A total of 269 women were included in the analyses. The incidence of GDM was 13.9% in the intervention group and 21.6% in the control group ([95% CI 0.40–0.98%]; P = 0.044, after adjustment for age, prepregnancy BMI, previous GDM status, and the number of weeks of gestation). Gestational weight gain was lower in the intervention group (−0.58 kg [95% CI −1.12 to −0.04 kg]; adjusted P = 0.037). Women in the intervention group increased their leisure time physical activity more and improved their dietary quality compared with women in the control group. CONCLUSIONS A moderate individualized lifestyle intervention reduced the incidence of GDM by 39% in high-risk pregnant women. These findings may have major health consequences for both the mother and the child. Introduction The prevalence of overweight and obesity are increasing worldwide (1). Obesity constitutes a major risk factor for type 2 diabetes (2), which it is estimated will affect almost half a billion people by 2030 (3 Continue reading >>
Gestational Diabetes Mellitus And Macrosomia: A Literature Review
Abstract Background: Fetal macrosomia, defined as a birth weight ≥4,000 g, may affect 12% of newborns of normal women and 15-45% of newborns of women with gestational diabetes mellitus (GDM). The increased risk of macrosomia in GDM is mainly due to the increased insulin resistance of the mother. In GDM, a higher amount of blood glucose passes through the placenta into the fetal circulation. As a result, extra glucose in the fetus is stored as body fat causing macrosomia, which is also called ‘large for gestational age'. This paper reviews studies that explored the impact of GDM and fetal macrosomia as well as macrosomia-related complications on birth outcomes and offers an evaluation of maternal and fetal health. Summary: Fetal macrosomia is a common adverse infant outcome of GDM if unrecognized and untreated in time. For the infant, macrosomia increases the risk of shoulder dystocia, clavicle fractures and brachial plexus injury and increases the rate of admissions to the neonatal intensive care unit. For the mother, the risks associated with macrosomia are cesarean delivery, postpartum hemorrhage and vaginal lacerations. Infants of women with GDM are at an increased risk of becoming overweight or obese at a young age (during adolescence) and are more likely to develop type II diabetes later in life. Besides, the findings of several studies that epigenetic alterations of different genes of the fetus of a GDM mother in utero could result in the transgenerational transmission of GDM and type II diabetes are of concern. © 2015 S. Karger AG, Basel Key Messages • Fetal macrosomia, resulting from fetal hyperinsulinemia in response to maternal diabetes, might be a predictor of later glucose intolerance. • Maternal diabetes during pregnancy can lead to a transgenerati Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Quality of Life in Women with Gestational Diabetes Mellitus: A Systematic Review
- Olive oil in the prevention and management of type 2 diabetes mellitus: a systematic review and meta-analysis of cohort studies and intervention trials
Guideline Summary: Gestational Diabetes Mellitus Evidence-based Nutrition Practice Guideline. [academy Of Nutrition And Dietetics]
Eating environment and meals eaten away from home Diet history and behavior: previous diets and diet adherence, disordered eating Factors affecting access to food: psychosocial/economic issues (e.g., social support) impacting nutrition therapy Pharmacologic therapy (including insulin or oral glucose-lowering agent) Substance use: alcohol, tobacco, caffeine, recreational drugs Use of dietary supplements, prenatal vitamins, over-the-counter medications, complementary and/or herbal Knowledge, beliefs or attitudes: motivation, readiness to change, self-efficacy; willingness and ability to make lifestyle changes Physical activity and function: exercise patterns, functionality for activities of daily living, sleep patterns Assessment of these factors is needed to effectively determine nutrition diagnoses and formulate a nutrition care plan. Inability to achieve optimal nutrient intake may contribute to poor outcomes. GDM: Assessment of Anthropometric Measurement of Women with GDM The RDN should assess the following anthropometric measurements in women with GDM, including but not limited to: Height, current weight, pre-pregnancy weight and body mass index (BMI) Assessment of these factors is needed to effectively determine nutrition diagnoses and formulate a nutrition care plan. GDM: Assessment of Biochemical Data, Medical Tests, and Procedures of Women with GDM The RDN should evaluate available data of women with GDM and recommend as indicated: biochemical data, medical tests and procedures including, but not limited to: Glycemic tests: glucose challenge test (GCT), oral glucose tolerance test (OGTT), glycosylated hemoglobin (A1C), fasting glucose, random glucose Use of self-monitoring blood glucose (SMBG) meters and urinary ketones, if recommended Maternal and fetal testing Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Role of Medical Nutrition Therapy in the Management of Gestational Diabetes Mellitus
- A Summary of ADA’s New 2018 Standards of Medical Care in Diabetes
Diabetes Mellitus And Pregnancy
Practice Essentials Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy. A study by Stuebe et al found this condition to be associated with persistent metabolic dysfunction in women at 3 years after delivery, separate from other clinical risk factors. [1] Infants of mothers with preexisting diabetes mellitus experience double the risk of serious injury at birth, triple the likelihood of cesarean delivery, and quadruple the incidence of newborn intensive care unit (NICU) admission. Gestational diabetes mellitus accounts for 90% of cases of diabetes mellitus in pregnancy, while preexisting type 2 diabetes accounts for 8% of such cases. Screening for diabetes mellitus during pregnancy Gestational diabetes The following 2-step screening system for gestational diabetes is currently recommended in the United States: Alternatively, for high-risk women or in areas in which the prevalence of insulin resistance is 5% or higher (eg, the southwestern and southeastern United States), a 1-step approach can be used by proceeding directly to the 100-g, 3-hour OGTT. The US Preventive Services Task Force (USPSTF) recommends screening for gestational diabetes mellitus after 24 weeks of pregnancy. The recommendation applies to asymptomatic women with no previous diagnosis of type 1 or type 2 diabetes mellitus. [2, 3] The recommendation does not specify whether the 1-step or 2-step screening approach would be preferable. Type 1 diabetes The disease is typically diagnosed during an episode of hyperglycemia, ketosis, and dehydration It is most commonly diagnosed in childhood or adolescence; the disease is rarely diagnosed during pregnancy Patients diagnosed during pregnancy most often present with unexpected Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Diabetes and Pregnancy: Fluctuating Hormones and Glucose Management
- Olive oil in the prevention and management of type 2 diabetes mellitus: a systematic review and meta-analysis of cohort studies and intervention trials
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 >>
The Challenges And Recommendations For Gestational Diabetes Mellitus Care In India: A Review
Gestational diabetes mellitus (GDM) is a primary concern in India affecting approximately five million women each year. Existing literature indicate that prediabetes and diabetes affect approximately six million births in India alone, of which 90% are due to GDM. Studies reveal that there is no consensus among physicians and health-care providers in India regarding management of GDM prepartum and postpartum despite available guidelines. Also, there is no consensus among physicians as to when a woman should undergo oral glucose tolerance test after delivery. This clearly shows that management of GDM is challenging and controversial in India due to conflicting guidelines and treatment protocols, despite availability of straightforward protocols for screening and management. Also, a collaborative approach remains a key for GDM management, as patient compliance and proper educational interventions promote better pregnancy outcomes. Management of GDM plays a pivotal role, as women with GDM have an increased chance of developing diabetes mellitus 5–10 years after pregnancy. Also, children born in GDM pregnancies face an increased risk for obesity and type 2 diabetes. The cornerstone for the management of GDM is glycemic control and quality nutritional intake. GDM management is complex in India, and existing challenges are multifactorial. However, there are little published data outlining these challenges. This review gives an account of some of the key challenges from self-management and health-care provider perspective. The recommendations in this review provide insights for building a more structured model for GDM care in India. This research has several practical applications. First, it points out to reaching a consensus on approaches for screening, diagnosis, and treatm Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- American Diabetes Association® Releases 2018 Standards of Medical Care in Diabetes, with Notable New Recommendations for People with Cardiovascular Disease and Diabetes
- Psychosocial care in the management of diabetes: America’s recommendations follow Indian guidelines
Prevalence Of Gestational Diabetes Mellitus In Korea: A National Health Insurance Database Study
Prevalence of Gestational Diabetes Mellitus in Korea: A National Health Insurance Database Study Contributed equally to this work with: Bo Kyung Koo, Joon Ho Lee Affiliations: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea, Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea Contributed equally to this work with: Bo Kyung Koo, Joon Ho Lee Affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea Affiliation: National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea Affiliation: National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea Affiliations: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea This article has been corrected. View correction This study aimed to estimate the prevalence of gestational diabetes mellitus (GDM) and use of anti-diabetic medications for patients with GDM in Korea, using data of the period 20072011 from the Health Insurance Review and Assessment (HIRA) database, which includes the claims data of 97% of the Korean population. We used the Healthcare Common Procedure Coding System codes provided by the HIRA to identify women with delivery in the HIRA database between 2009 and 2011. GDM was defined according to ICD-10 codes, and patients with pre-existing diabetes between January 1, 2007 and pregnancy were excluded. A Poisson regression was performed to evaluate the trends in annual prevalence rates. T Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Health Insurance Plan for Diabetes Patients: Check out 3 of the best insurance policies available inIndia
- JDRF Launches Health Insurance Guide to Help People with Type 1 Diabetes Navigate Common Insurance Challenges
The Insulin-like Growth Factor Axis: A New Player In Gestational Diabetes Mellitus?
Gestational diabetes mellitus (GDM), defined as glucose intolerance of varying severity with first onset and recognition in pregnancy, is a diagnosis that holds relevance for the diabetes epidemic across two generations—that of the mother and her child (1,2). Indeed, despite typically regaining normal glucose tolerance in the immediate postpartum, women with previous GDM have a very high risk of future progression to type 2 diabetes (T2D) (3). Similarly, their offspring have an elevated risk of accruing metabolic abnormalities in childhood that may be partly attributable to the intrauterine environment of the GDM pregnancy (4). As such, enhanced understanding of the pathophysiology of GDM could yield strategies for early identification of at-risk mothers and ideally mitigation of their metabolic risk, to the benefit of both mother and child (2). Current understanding of the pathophysiology of GDM holds that affected women have a defect in pancreatic β-cell function that first manifests clinically as an inability to fully compensate for the marked insulin resistance of the latter half of pregnancy, resulting in characteristic hyperglycemia in late second or third trimester (1,2). Importantly, although this clinical presentation arises in response to the physiologic stress test posed by pregnancy, affected women have chronic β-cell dysfunction and insulin resistance that is readily apparent in the years thereafter and that contributes to their elevated lifetime risk of T2D (5,6). Moreover, it is now recognized that metabolic dysfunction actually long precedes the development of GDM, leading to the recent emergence of a host of markers that may enable the early identification of at-risk women in first trimester and even prior to pregnancy (7–11) (Fig. 1). Figure 1 Ci Continue reading >>
Gestational Diabetes Mellitus: Challenges In Diagnosis And Management
Abstract Gestational diabetes mellitus (GDM) is a well-characterized disease affecting a significant population of pregnant women worldwide. It has been widely linked to undue weight gain associated with factors such as diet, obesity, family history, and ethnicity. Poorly controlled GDM results in maternal and fetal morbidity and mortality. Improved outcomes therefore rely on early diagnosis and tight glycaemic control. While straightforward protocols exist for screening and management of diabetes mellitus in the general population, management of GDM remains controversial with conflicting guidelines and treatment protocols. This review highlights the diagnostic and management options for GDM in light of recent advances in care. Introduction Gestational diabetes mellitus (GDM), by definition, is any degree of glucose intolerance with onset or first recognition during pregnancy [1, 2]. This definition applies regardless of whether treatment involves insulin or diet modification alone; it may also apply to conditions that persist after pregnancy. GDM affects roughly 7 % of pregnancies with an incidence of more than 200,000 cases per year [2]. The prevalence, however, varies from 1–14 %, depending on the population and the diagnostic criteria that have been used [2]. GDM is the most common cause of diabetes during pregnancy, accounting for up to 90 % of pregnancies complicated by diabetes [2]. Women with GDM have a 40–60 % chance of developing diabetes mellitus over the 5–10 years after pregnancy [3]. Although GDM has been recognized as a disease for some time, it remains a controversial entity with conflicting guidelines and treatment protocols. Review Screening The first screening test for GDM, proposed in 1973, consisted of the 1-h 50 gm oral glucose tolerance test Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Complicated urinary tract infections associated with diabetes mellitus: Pathogenesis, diagnosis and management
- Management of pancreatogenic diabetes: challenges and solutions
Seasonality Of Gestational Diabetes Mellitus: A South Australian Population Study
Abstract Objective To investigate whether there is a seasonal variation in the incidence of gestational diabetes mellitus (GDM). Research design and methods This retrospective cohort study of 60 306 eligible South Australian live-born singletons during 2007–2011 recorded in the South Australian Perinatal Statistics Collection (SAPSC) examined the incidence of GDM in relation to estimated date of conception (eDoC). Fourier series analysis was used to model seasonal trends. Results During the study period, 3632 (6.0%) women were diagnosed with GDM. Seasonal modeling showed a strong relation between GDM and eDoC (p<0.001). Unadjusted and adjusted models (adjusted for maternal age, body mass index (BMI), parity, ethnicity, socioeconomic status, and chronic hypertension) demonstrated the presence of a peak incidence occurring among pregnancies with eDoC in winter (June/July/August), with a trough for eDoc in summer (December/January/February). As this was a retrospective study, we could only use variables that had been collected as part of the routine registration system, the SAPSC. Conclusions This study is the first population-based study to demonstrate a seasonal variation for GDM. Several maternal lifestyle and psychosocial factors associated with seasonality and GDM may be influential in the pathophysiologic mechanisms of GDM. Ambient temperature, physical activity, nutrient intake, and vitamin D levels may affect maternal physiology, and fetal and placental development at the cellular level and contribute to the development of GDM. The mechanisms underlying these possible associations are not fully understood and warrant further investigation. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR–INDIAB population-based cross-sectional study
- Maternal obesity as a risk factor for early childhood type 1 diabetes: a nationwide, prospective, population-based case–control study
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 >>
Gestational Diabetes Mellitus (gdm)
Published by Phebe Hodge Modified about 1 year ago Presentation on theme: "Gestational Diabetes Mellitus (GDM)" Presentation transcript: Presentation title Date Gestational Diabetes Mellitus (GDM) Training, Madhya Pradesh 1-2 April, 2016 Dr Sachin Chittawar DM (Endocrinology) 2 Agenda Diabetes a public health crisis Presentation title Date Agenda Diabetes a public health crisis Diabetes and maternal health and pregnancy Gestational diabetes and pregnancy outcomes National guidelines for diagnosis and management of GDM Testing for GDM Management of GDM Presentation title Date Diabetes a public health crisis 4 Globally diabetes has reached pandemic status Presentation title Date Globally diabetes has reached pandemic status As of 2015 415 million people have diabetes1 318 million people have prediabetes*,1 * Prediabetes is the number of people estimated to have impaired glucose tolerance, a precursor to developing type 2 diabetes Source: IDF Diabetes Atlas, 7th edn. Brussels, Belgium: International Diabetes Federation, 2015 5 Numbers are also rapidly increasing in India Presentation title Date Numbers are also rapidly increasing in India Number of adults (2079) with diabetes in India 36 million people are undiagnosed (52%)2 124 million people 69 million people 51 million people 20091 20152 20402 IDF Diabetes Atlas, 4th edn. Brussels, Belgium: International Diabetes Federation, 2009 IDF Diabetes Atlas, 7th edn. Brussels, Belgium: International Diabetes Federation, 2015 6 Diabetes is associated with serious complications Presentation title Date Diabetes is associated with serious complications Consistently high blood glucose levels can lead to serious disease affecting the heart and blood vessels, eyes, kidneys and nerves STROKE Strokes are up to four times as likely BLIND Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Timing of Delivery in Gestational Diabetes Mellitus: Need for Person-Centered, Shared Decision-Making
- Quality of Life in Women with Gestational Diabetes Mellitus: A Systematic Review
Patient Education: Gestational Diabetes Mellitus (beyond The Basics)
INTRODUCTION Insulin is a hormone whose job is to enable glucose (sugar) in the bloodstream to enter the cells of the body, where sugar is the source of energy. All fetuses (babies) and placentas (afterbirths) produce hormones that make the mother resistant to her own insulin. Most pregnant women produce more insulin to compensate and keep their blood sugar level normal. Some pregnant women cannot produce enough extra insulin and their blood sugar level rises, a condition called gestational diabetes. Gestational diabetes affects between 5 and 18 percent of women during pregnancy, and usually goes away after delivery. It is important to recognize and treat gestational diabetes to minimize the risk of complications to mother and baby. In addition, it is important for women with a history of gestational diabetes to be tested for diabetes after pregnancy because of an increased risk of developing type 2 diabetes in the years following delivery. More detailed information about gestational diabetes is available by subscription. (See "Diabetes mellitus in pregnancy: Screening and diagnosis".) GESTATIONAL DIABETES TESTING We recommend that all pregnant women be tested for gestational diabetes. Identifying and treating gestational diabetes can reduce the risk of pregnancy complications. (See "Diabetes mellitus in pregnancy: Screening and diagnosis".) Complications of gestational diabetes can include: Having a large baby (weighing more than 9 lbs or 4.1 kg), which can increase the risk of injury to the mother or baby during delivery and increase the chance of needing a cesarean section. Stillbirth (a baby who dies before being born), a complication which fortunately is now rare in women with gestational diabetes because of good control of blood sugars and careful monitoring of mo Continue reading >>
