Post Birth Diabetes Testing
Gestational diabetes increases your risk of developing type 2 diabetes after the pregnancy. Statistics from Diabetes UK state that there is a seven-fold increased risk in women with gestational diabetes developing type 2 diabetes in later life. NICE state that up to 50% of women diagnosed with gestational diabetes develop type 2 diabetes within 5 years of the birth. A 2002 publication from Diabetes Care comparing 28 studies found that elevated fasting levels during pregnancy was the most common risk factor associated with future risk of type 2 diabetes: Cumulative incidence of type 2 diabetes increased markedly in the first 5 years after delivery and appeared to plateau after 10 years. An elevated fasting glucose level during pregnancy was the risk factor most commonly associated with future risk of type 2 diabetes. It is recommended that you should have a fasting glucose blood test at 6 weeks post-partum OR a HbA1c blood test after 13 weeks post-partum to check that you are clear of diabetes. It is no longer recommended that a repeat GTT is performed to check that the diabetes is clear (NICE guidelines Feb 2015). However it may still be offered in Scotland and Ireland or in hospitals which are not following the NICE recommendations. Many ladies have concerns over taking a fasting glucose test whilst breast feeding, or attending for blood tests whilst their newborn is still very young. If you have these concerns then you may want to opt for a HbA1c blood test after 13 weeks post-partum. You do not need to fast and it is one simple blood test that can be taken at your local GP surgery. High levels after giving birth You should eat a normal diet following the birth of your baby. Some hospitals will advise to continue testing blood sugar levels after giving birth. Be prepa Continue reading >>
Top Tips: Type 2 Diabetes
Dr Kevin Fernando provides top tips on diagnosing and managing type 2 diabetes and identifying people at high risk identifying people at risk of developing type 2 diabetes and gestational diabetes tailoring the HbA1c target to the individual structured education programmes and educational resources that can help patients to self-manage their diabetes. The State of the nation 2016 (England)time to take control of diabetes report from Diabetes UK warns that 5 million people in England are at high risk of developing type 2 diabetes mellitus (T2DM).1 High-quality evidence from several international diabetes prevention studies shows that early lifestyle intervention can reduce both long-term progression to T2DM,2 and long-term incidence of cardiovascular and all-cause mortality.3 Based on the evidence from five large-scale and tightly controlled randomised trials,3 the NHS Diabetes Prevention Programme46 was launched during 2016 to provide individualised lifestyle support for those at high risk of T2DM. 1 Identify people who are at high risk of T2DM on your practice register NICE Public Health Guideline (PHG) 38 Type 2 diabetes: prevention in people at high risk recommends the use of a risk-assessment tool such as the QDiabetes-2016 risk calculator to identify patients at high risk of T2DM.7,8 The tool calculates an individuals 10-year risk of developing diabetes; in general, 10% or above is considered high risk.7 NICE PHG38 provides a useful flowchart (see Figure 1, below) outlining recommended interventions for patients at various levels of risk of T2DM:8 if low/medium risk, offer brief advice on the following, at least every 5 years if HbA1c is <42 mmol/mol the patient is at moderate risk; offer a brief intervention and reassess risk at least every 3 years if HbA1c is 42 Continue reading >>
A Cost-effectiveness Comparison Of The Nice 2015 And Who 2013 Diagnostic Criteria For Women With Gestational Diabetes With And Without Risk Factors
A cost-effectiveness comparison of the NICE 2015 and WHO 2013 diagnostic criteria for women with gestational diabetes with and without risk factors 2 St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, 1 Royal College of Obstetricians and Gynaecologists, London, UK, 2 St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, 3 Centre for Public Health, Queen's University Belfast, Belfast, UK, 4 Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK, 5 Department of Investigative Medicine, Hammersmith Hospital, Imperial College London, London, UK, 6 Newcastle University Medicine Malaysia, Johor, Malaysia, Correspondence to Paul Brian Jacklin; [email protected] Author information Article notes Copyright and License information Disclaimer Received 2017 Mar 3; Revised 2017 Jun 9; Accepted 2017 Jun 22. Copyright Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: To compare the cost-effectiveness (CE) of the National Institute for Health and Care Excellence (NICE) 2015 and the WHO 2013 diagnostic thresholds for gestational diabetes mellitus (GDM). The anal Continue reading >>
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Sade Pblica - Controversies In Screening And Diagnosis Of Gestational Diabetes: Cubas Position Controversies In Screening And Diagnosis Of Gestational Diabetes: Cubas Position
Perspective International Journal of Cuban Health & Medicine 18 (3) July2016 copy Controversies in Screening and Diagnosis of Gestational Diabetes: Cubas Position Gestational diabetes is the most common endocrine disorder affecting pregnant women and its prevalence is on the rise. Prevalence in Cuba is about 5.8%, and global prevalence ranges from 2% to 18% depending on the criteria applied. Gestational diabetes can lead to adverse gestational outcomes, such as fetal death, preterm delivery, dystocia, perinatal asphyxia and neonatal complications. Prompt, accurate diagnosis allowing early treatment can benefit both mother and child. The disease is asymptomatic, so clinical laboratory testing plays a key role in its screening and diagnosis. Cubas approach to diabetes screening and diagnosis differs from some international practices. All pregnant women in Cuba are screened with a fasting plasma glucose test and diagnosed using modified WHO criteria. Some international recommendations are to skip the screening step and instead follow the diagnostic criteria of the Hyperglycemia and Adverse Pregnancy Outcomes study. In Cuba, gestational outcomes for women with diabetes (including gestational diabetes) are satisfactory (preeclampsia 5%; preterm delivery 12%; neonatal macrosomia 7.5%; congenital abnormalities 4.3% and perinatal deaths 4.8%). These data do not indicate a need to change established screening and diagnostic criteria. Gestational diabetes; screening; diagnosis; early detection; early diagnosis; Cuba Gestational diabetes (GD) is the most common endocrine disorder affecting pregnant women and its prevalence is on the rise. Prevalence in Cuba is about 5.8%; global prevalence estimates range from 2% to 18% depending on the criteria applied. [11. Marquez A, Aldana D, Continue reading >>
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Nice Updates Type 2 Diabetes Guidance
Guidelines to help healthcare professionals to identify adults at high risk of type2 diabetes have been updated. The National Institute for Health and Care Excellence (NICE) has issued the newly updated document , saying it aims to remind practitioners that age is no barrier to being at high risk of, or developing, the condition. It is also hoped the guideline will help healthcare professionals provide those at high risk with an effective and appropriate intensive lifestyle-change programme in a bid to prevent or delay the onset of type2 diabetes. The updates state that when commissioning local or national services to deliver intensive lifestyle-change programmes is being considered, if availability of places is limited, people with a fasting plasma glucose of 6.56.9mmol/l or HbA1c of 4447mmol/mol [6.26.4 per cent] should be prioritised. It also statesthat intensive lifestyle-change programmes are designed to help as many people as possible to access and take part in them. Changes to metformin recommendations have also been made. NICE suggests: Clinical judgement on whether (and when) to offer metforminto support lifestyle change for people whose HbA1c or fasting plasma glucose blood test results have deteriorated if this has happened despite their participation in intensive lifestyle-change programmes or if hey are unable to participate in an intensive lifestyle-change programme, particularly if they have a BMI greater than 35. The recommendations in the guideline can be used alongside the NHS Health Check programme .A guideline on population and community-level interventions for preventing type 2 diabetes has also been produced, which recommends how to tailor services for people in ethnic communities and other groups who are particularly at risk of type 2 diabetes. T Continue reading >>
Diabetes In Pregnancy (nice Clinical Guideline 3)
This guideline was produced by the National Collaborating Centre for Women’s and Children’s Health (NCC-WCH) on behalf of the National Institute of Health and Care Excellence (NICE). The guideline focuses on areas where additional or different care should be offered to women with diabetes and their newborn babies. Where the evidence supports it, the guideline makes separate recommendations for women with pre‑existing diabetes and women with gestational diabetes. Continue reading >>
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 >>
Gps Told To Consider 'relaxing' Diabetes Targets In Some Patients By Nice
GPs told to consider 'relaxing' diabetes targets in some patients by NICE GPs have been told to consider not treating elderly or very ill patients with type 2 diabetes to such strict HbA1c targets, under new NICE guidelines published today. The long-awaited guideline suggests a more individual approach to patients who may not have so much to gain from very low blood glucose levels and that targets must be applied on acase-by-case basis. It also gives the green light to make more use of a wider range of glucose-lowering drugs, recommendinggliptins and gliflozins are offered second-line alongside metformin. NICE advisors said the updates marked a major step in helping GPs to tailor treatment to their individual patients. However, some critics, including GP diabetes experts, said NICE should have pushed some of the newly available therapies harder in light of latest evidence, although they welcomed NICEs pledge to set up a dedicated committee to help keep the guidelines more up to date in future. The final guidelines publication - the first time NICE has updated the recommendations in six years - come after an extraordinary second round of consultations that was triggered by a number of fierce criticisms of earlier drafts, when GP experts expressed dismay at bonkers and truly retrograde recommendations on glucose-lowering treatment. NICE advisors have now bowed to some of these pressures, notably to update the glucose-lowering treatment algorithm to include the dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins) and sodium-glucose cotransporter 2 (SGLT2) inhibitors also known as gliflozins in order to intensify treatment. GPs can now choose a gliptin, pioglitazone, sulfonylurea or a gliflozin, depending on the patients individual profile and preferences, as an add-on to Continue reading >>
Guidelines
There is now extensive evidence on the optimal management of diabetes, offering the opportunity of improving the immediate and long-term quality of life of those living with the condition. Unfortunately such optimal management is not reaching many, perhaps the majority, of the people who could benefit. Reasons include the size and complexity of the evidence-base, and the complexity of diabetes care itself. One result is a lack of proven cost-effective resources for diabetes care. Another result is diversity of standards of clinical practice. Guidelines are part of the process which seeks to address those problems. IDF has produced a series of guidelines on different aspects of diabetes management, prevention and care. The new IDF Clinical Practice Recommendations for managing Type 2 Diabetes in Primary Care seek to summarise current evidence around optimal management of people with type 2 diabetes. It is intended to be a decision support tool for general practitioners, hospital based clinicians and other primary health care clinicians working in diabetes. Pocket chart in the format of a Z-card with information for health professionals to identify, assess and treat diabetic foot patients earlier in the "window of presentation" between when neuropathy is diagnosed and prior to developing an ulcer. The content is derived from the IDF Clinical Practice Recommendations on the Diabetic Foot 2017. Available to download and to order in print format. The IDF Clinical Practice Recommendations on the Diabetic Foot are simplified, easy to digest guidelines to prioritize health care practitioner's early intervention of the diabetic foot with a sense of urgency through education. The main aims of the guidelines are to promote early detection and intervention; provide the criteria for Continue reading >>
Nice Type 2 Diabetes Prevention Guideline | Nice Guideline | Guidelines For Nurses
This Guidelines for Nurses summary is deliberately concisecovering recommendations 16, 89, 1116, and 1920. For the complete list of recommendations, please refer to the full guideline GPs and other health professionals and community practitioners in health and community venues should implement a two-stage strategy to identify people at high risk of type 2 diabetes (and those with undiagnosed type 2 diabetes). First, a risk assessment should be offered (see recommendation 3 ). Second, where necessary, a blood test should be offered to confirm whether people have type 2 diabetes or are at high risk (see recommendation 4 ) Service providers including pharmacists, managers of local health and community services and voluntary organisations, employers, and leaders of faith groups should offer validated self-assessment questionnaires or validated web-based tools (for examples, see the Diabetes UK website ). They should also provide the information needed to complete and interpret them. The tools should be available in local health, community, and social care venues. Examples of possible health venues include: community pharmacies, dental surgeries, NHS walk-in centres, and opticians. Examples of community and social care venues include: workplaces, job centres, local authority leisure services, shops, libraries, faith centres, residential and respite care homes and day centres (for older adults and for adults with learning disabilities) Public health, primary care, and community services should publicise local opportunities for risk assessment and the benefits of preventing (or delaying the onset of) type 2 diabetes. The information should be up-to-date and provided in a variety of formats. It should also be tailored for different groups and communities. For example, by offer Continue reading >>
Gestational Diabetes - General Practice Notebook
Gestational diabetes now includes both gestational impaired glucose tolerance and gestational diabetes mellitus (1). approximately 700,000 women give birth in England and Wales each year, and up to 5% of these women have either pre-existing diabetes or gestational diabetes of women who have diabetes during pregnancy estimated that 87.5% have gestational diabetes - which is defined as the development of diabetes during pregnancy (which may or may not resolve after pregnancy), prevalence of type 1 diabetes, and especially type 2 diabetes, has increased in recent years incidence of gestational diabetes is also increasing as a result of higher rates of obesity in the general population and more pregnancies in older women diabetes in pregnancy is associated with risks to the woman and to the developing fetus. Miscarriage, pre-eclampsia and preterm labour are more common in women with pre-existing diabetes. In addition, diabetic retinopathy can worsen rapidly during pregnancy. Stillbirth, congenital malformations, macrosomia, birth injury, perinatal mortality and postnatal adaptation problems (such as hypoglycaemia) are more common in babies born to women with pre-existing diabetes NICE (2) suggest testing criteria for gestational diabetes as: use the 2-hour 75 g oral glucose tolerance test (OGTT) to test for gestational diabetes in women with risk factors (see below) offer women who have had gestational diabetes in a previous pregnancy: early self-monitoring of blood glucose or a 75 g 2-hour OGTT as soon as possible after booking (whether in the first or second trimester), and a further 75 g 2-hour OGTT at 24-28 weeks if the results of the first OGTT are normal offer women with any of the other risk factors for gestational diabetes a 75 g 2-hour OGTT at 24-28 weeks (see bel Continue reading >>
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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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Nice Guidelines & Funding Continuous Glucose Monitoring
NICE guidelines & funding continuous glucose monitoring NICE guidelines & funding continuous glucose monitoring 1.6.22Consider real-time continuous glucose monitoring for adults with type 1 diabetes who are willing to commit to using it at least 70% of the time and to calibrate it as needed, and who have any of the following despite optimised use of insulin therapy and conventional blood glucose monitoring: More than 1 episode a year of severe hypoglycaemia with no obviously preventable precipitating cause. Complete loss of awareness of hypoglycaemia Frequent (more than 2 episodes a week) asymptomatic hypoglycaemia that is causing problems with daily activities. Hyperglycaemia (HbA1c level of 75 mmol/mol [9%] or higher) that persists despite testing at least 10 times a day (see recommendations 1.6.11 and 1.6.12). Continue real-time continuous glucose monitoring only if HbA1c can be sustained at or below 53 mmol/mol (7%) and/or there has been a fall in HbA1c of 27 mmol/mol (2.5%) or more. [New 2015] 1.6.23 For adults with type 1 diabetes who are having real-time continuous glucose monitoring, use the principles of flexible insulin therapy with either a multiple daily injection insulin regimen or continuous subcutaneous insulin infusion (CSII or insulin pump) therapy. [New 2015] 1.6.24 Real-time continuous glucose monitoring should be provided by a centre with expertise in its use, as part of strategies to optimise a persons HbA1c levels and reduce the frequency of hypoglycaemic episodes. [New 2015] NICE Guidelines for managing diabetes with Continuous Glucose Monitoring in children: 1.2.62Offer ongoing real-time continuous glucose monitoring with alarms to children and young people with type 1 diabetes who have: impaired awareness of hypoglycaemia associated with advers Continue reading >>
Natural Selection? The Evolution Of Diagnostic Criteria For Gestational Diabetes
Gestational diabetes is a common pregnancy disorder which is generally managed with diet, exercise, metformin or insulin treatment and which usually resolves after delivery of the infant. Identifying and treating gestational diabetes improves maternal and fetal outcomes and allows for health promotion to reduce the mother’s risk of type 2 diabetes in later life. However, there remains considerable controversy about the optimal method of identification and diagnosis of women with gestational diabetes. The NICE-2015 diagnostic criteria (75 g oral glucose tolerance test (OGTT) 0 h ≥5.6 mmol/L; 2 h ≥7.8 mmol/L) are based upon cost-effectiveness estimates using observational data, while the WHO-2013 criteria (75 g OGTT 0 h ≥5.1 mmol/L; 1 h ≥10.0 mmol/L; 2 h ≥8.5 mmol/L) identify women and infants at risk of adverse outcomes according to prospective data. There is also considerable controversy about testing for gestational diabetes using universal or risk factor-based screening, and when and how testing should be performed. The aim of this review is to provide a summary of the clinical biochemistry aspects to these debates and to highlight the importance of appropriate identification of gestational diabetes and subsequent type 2 diabetes in this population. 1. Metzger, BE, Coustan, DR. Summary and recommendations of the fourth international workshop – conference on gestational diabetes mellitus. The Organizing Committee. Diabetes Care 1998; 21(Suppl 2): B161–B167. Google Scholar, Medline 2. World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy, Geneva: WHO, 2013. Google Scholar 3. Simmons D. Epidemiology of diabetes in pregnancy. In: McCance DR, Maresh M and Sacks DA (eds) Practical Management of Diabet Continue reading >>
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:: Leicestershire Diabetes :: Leicestershire Diabetes Guidelines
Leicestershire Diabetes Guidelines October 2016 The NEW updated and revised Leicestershire Diabetes Guidelines for the Management of Diabetes in line with NICE Guidances are now available to download, click on the links below. Use of HbA1c in diagnosing Diabetes 2013 - LDC These guidelines have been produced by the University Hospitals of Leicester (UHLs) NHS Trusts Department of Diabetes and Endocrinology working in Partnership with Primary Care Trusts across Leicestershire and Rutland for the management of diabetes and related problems. Including the East Midlands Renal Network (EMRN) The Diabetes Management Guidelines are NHS approved and have been produced for use within the department and to be distributed to the Primary Care Trusts and hence the General Practitioner and Medical Centres across Leicestershire and Rutland. The leicestershirediabetes.org.uk website has made these available to download for use by any members of the NHS organisation. (Please can we ask that you acknowledge Leicestershire Diabetes as the source of your information) Continue reading >>
