Pdf gestational diabetes mellitus indian guidelines. In some cases, you will also need to learn how to give yourself insulin injections or take a pill to lower your blood sugar levels. The fasting plasma glucose level frequencies in the lowest and highest categories, respectively, were 5. It is usually found during pregnancy medical checks. Finally, gdm is a wellestablished risk factor for developing dm. Type 1 diabetes previously known as insulindependent or childhoodonset diabetes is characterized by a lack of insulin production.
Gestational diabetes mellitus indian guidelines article pdf available in journal of the indian medical association 10711. Maternity and neonatal clinical guideline department of health gestational diabetes mellitus. Gdm carries a small but potentially important risk of adverse perinatal outcomes and a longerterm risk of obesity and glucose intolerance in offspring. Definisi dm diabetes melitus adalah suatu keadaan didapatkan peningkatan kadar gula darah yang kronik sebagai akibat dari gangguan pada metabolisme karbohidrat, lemak, dan protein karena kekurangan hormone insulin. Type 2 diabetes formerly called noninsulindependent or adultonset diabetes is caused by the bodys ineffective use of insulin. The entity usually presents in the second or during the third trimester. Gestational diabetes mellitus 2016 guideline presentation. Gestational diabetes mellitus is defined as glucose intolerance of variable severity with onset or first recognition during pregnancy. The 2002 national institute for health and clinical excellence nice health technology assessment concluded. Gestational diabetes gdm any degree of glucose intolerance with onset or first recognition during pregnancy.
The main goal of treatment for gestational diabetes is to reduce the risk of complications such as those mentioned above. It often results from excess body weight and physical inactivity. The pathogenesis involves the combination of insulin resistance and defective insulin secretion. Gestational diabetes mellitus trial gdm full text view. Association of gestational diabetes mellitus gdm with. Gestational diabetes mellitus and treatment adherence. Main outcome measure perceived impact of gestational diabetes mellitus was measured with the impact of event scale. By necessity, this panel, diagnosing gestational diabetes mellitus, cannot address every controversy surrounding gdm and focused on diagnosis. Whether there is a direct correlation between gdm and elevated cimt is still controversial. The term diabetes mellitus dm describes a metabolic disorder that affects the normal metabolism of carbohydrates, fats and protein. Nutritional management gestational diabetes mellitus. Gestational diabetes mellitus gestational diabetes mellitus is carbohydrates intolerance of variable severity with onset or first recognition during the present pregnancy. However, the panel is cognizant of the fact that most healthcare providers in the united states currently screen, and will continue to screen, for this condition. However, debate continues to surround the diagnosis and treatment of gdm despite several recent largescale studies addressing these issues.
Maternal and neonatal outcomes of gestational diabetes. Screening, diagnosis, and management of gestational diabetes mellitus andrew garrison, md, central city community health center and the university of utah, salt lake city, utah. Unmodifiable risk factors such as age, genetic background. Gestational diabetes mellitus gdm is a glucose tolerance disorder of any severity occurring for the first time or diagnosed during pregnancy. Infants with ndm do not produce enough insulin, leading to an increase in blood glucose. Consultant, mh, mohfw 29 dr ravinder kaur senior consultant, mh, mohfw 30 dr gulfam ahmed hashmi regional coordinator, nru, mohfw 31 dr sonali rawal nhm consultant, mohfw. The definition applies regardless of insulin use for treatment or the persistence of the condition after pregnancy, and does not exclude the possibility that unrecognized glucose intolerance or overt diabetes may have preceded the pregnancy. This type of gestational diabetes must be controlled by insulin a2. In children, it may present with classical insulin deficiency and ketoacidosis at disease onset, whereas autoimmune diabetes in adults may not always be insulin dependent. It is a rare condition occurring in only one in 100,000 to 500,000 live births. The international federation of gynecology and obstetrics.
Gestational diabetes mellitus is defined as glucose intolerance that is first detected during pregnancy. Masalah utama pada penderita dm ialah terjadinya komplikasi, khususnya. Insulin should run in a separate cannula to all other. Women with gestational diabetes have twice the risk of developing hypertensive disorders such as preeclampsia, and the baby usually has macrosomia. Diagnosis and management of gestational diabetes mellitus.
Carotid intimamedia thickness cimt is increasingly used as a noninvasive marker for subclinical atherosclerosis. The frequency of gdm is rising globally and may also increase further as lessstringent criteria for the diagnosis are potentially adopted. Gestational diabetes mellitus refer to online version, destroy printed copies after use page 2 of 38 document title. Treatment adherence included the percentage of recommended blood glucose selfmonitoring, incidence of hypo and. It has been widely linked to undue weight gain associated with factors such as diet, obesity, family history, and ethnicity. Metformin in women at high risk of gestational diabetes mellitus. Prevalence of gestational diabetes mellitus and gestational impaired glucose tolerance in pregnant women evaluated by national diabetes data group and carpenter and coustan criteria. Gestational diabetes mellitus gdm represents a heterogeneous group of metabolic disorders, which result in varying degrees of maternal hyperglycemia and pregnancyassociated risk. Gestational diabetes mellitus shares common features with type 2 diabetes mellitus t2dm and its history represents a major risk factor for the development of t2dm later in life elnour et al. Guideline for the management of preexisting and gestational diabetes in pregnancy 7 all women with type 1 diabetes will require a sliding scale 50units actrapid in 50mls n. Gestational diabetes mellitus gestational diabetes mellitus gdm is one of the most common medical complications of pregnancy. If the increased risk of fetal demise in patients with preexisting diabetes is related to suboptimal metabolic control, it would be expected that patients with. Frequency of gestational diabetes mellitus and the associated risk.
Explain the management diabetes in pregnancy list the nursing diagnoses of diabetes in pregnancy research evidence references 3. Maternal and neonatal outcomes of gestational diabetes mellitus 324 p j m h s vol. Gestational diabetes simple english wikipedia, the free. The 49slide presentation includes all recommendations and ratings for the academys eal 2016 gestational diabetes mellitus evidencebased nutrition practice guideline. Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes mellitus gdm is a wellcharacterized disease affecting a significant population of pregnant women worldwide. Test for gestational diabetes mellitus at 2428 weeks of gestation in pregnant women not previously known to have diabetes. Neonatal diabetes mellitus ndm is a monogenic form of diabetes that occurs in the first six months of life. Neonatal diabetes mellitus an update on diagnosis and management michelle blanco lemelman, mda, lisa letourneau, mph, rd, ldnb, siri atma w. Gestational diabetes mellitus gdm is increasing in prevalence in tandem with the dramatic increase in the prevalence of overweight and obesity in women of childbearing age.
Department of health and human services, nonadvocate 15member panel representing the fields of obstetrics and gynecology, maternalfetal medicine, pediatrics, diabetic research, biostatistics, womens health issues, health services research, decision analysis, health. The ghrelin system and gestational diabetes mellitus. About 15,000 infants are born to mothers with diabetes each year. Background historically, there has been controversy over screening and diagnosis of gestational diabetes. The warning symptoms of type 1 diabetes include polyuria, polydipsia, and polyphagia due to hyperglycemia.
Also, effective prevention strategies in this area are still lacking, and controversies exist regarding diagnosis and management of this form of diabetes. Implementation tip unlike a clinical practice guideline, this document does not offer recommendations for care. Gestational diabetes mellitus gdm is considered as the most common medical condition during pregnancy which begins or is diagnosed with. Gestational diabetes mellitus gdm is any abnormal glucose tolerance first detected during pregnancy. Diagnostic criteria and classification of hyperglycaemia first. An additional reason could be further deterioration of lifestyle. The clinical and public health relevance of gestational diabetes mellitus gdm is widely debated due to its increasing incidence, the resulting negative economic impact, and the potential for severe gdmrelated pregnancy complications.
Gdm is associated with increased perinatal morbidity, the characteristics of which are the same as for infants of. Poorly controlled gdm results in maternal and fetal morbidity and mortality. What are the current recommendations for the management of gestational diabetes mellitus from the american college of obstetricians and. Gestational diabetes generally results in few symptoms. Gestational diabetes mellitus idf school of diabetes. From 2002 to march 2017, the world diabetes foundation provided usd million in funding to 511 projects in 115 countries. Treatment of gestational diabetes gdm is effective in reducing macrosomia, large for gestational age, shoulder dystocia and preeclampsiahypertensive. Management of gestational diabetes mellitus jmaj 545.
The main reason for this high probability is that, as time goes by, functional reserves of the pancreas are reduced. Nih diagnosing gestational diabetes mellitus conference. There are varying and similar presentations between patients with type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes, prediabetes, and glucose intolerance. Quality of life and gestational diabetes mellitus international. Gestational diabetes mellitus and nursing management. Gestational diabetes mellitus gdm represents glucose levels in the high end of the population distribution during pregnancy. This issue of the mjm includes one article on gestational diabetes mellitus gdm drawn from the national obstetric registry nor of malaysia by muneswaran g.
Much controversy surrounds the diagnosis and management of gestational diabetes, emphasizing the importance and relevance of clarity and consensus. Since 1980, the international workshopconference on gestational diabetes and the american diabetic association has recommended universal screening for gestational diabetes between 24 and 28 weeks of gestation. Current management of gestational diabetes mellitus. Gestational diabetes mellitus gdm diagnosis, therapy and. Hyperemesis is not seen with gestational diabetes, nor is there an association with low birth weight of the infant. There is continued controversy surrounding the detection and management of gestational diabetes mellitus gdm. Screening for gestational diabetes mellitus gdm based on risk factors using. Greeley, md, phdc, introduction diabetes mellitus most commonly occurs after the neonatal period and results from.
The occurrence of gdm parallels the prevalence of impaired glucose tolerance igt, obesity, and type 2 diabetes mellitus. Gestational diabetes mellitus gdm is a global health concern, not only because. Patients with gdm are best managed in a combined clinic with close collaboration between the obstetric and diabetic teams. Diagnosis and management of gestational diabetes mellitus david c. Gestational diabetes mellitus case studies by our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. Screening, diagnosis, and management of gestational. The queensland clinical guideline gestational diabetes mellitus is the primary reference for this package recommended citation. Lifestyle management with medical nutrition therapy and exercise is primary therapeutic intervention for gdm insulin is the only appropriate first line therapy. Gestational diabetes mellitus gdm is associated with an elevated risk of adverse health outcomes such as type 2 diabetes and cardiovascular diseases. Gestational diabetes mellitus clinical guideline education presentation e15. Comments on gestational diabetes mellitus future pregnancy. Lash, md, university of michigan medical school, ann arbor, michigan.