Gestational diabetes
| Headline | |
|---|---|
| Etiology | |
| Epidemiology | WHO screening criteria: BMI > 30kg/m2, previous GDM, first-degree relative with diabetes, previous macrosomia >4.5kg, ethnic origin: South Asia, Caribbean, Middle East, PCOS |
| Clinical presentation | Large for dates Complications: ↑ risk miscarriage, pre-eclampsia etc. |
| Pathogenesis | |
| Diagnostic investigations | 2h 75mg OGTT; dx confirmed with: ➥ Fasting glucose ≥ 5.6mmol/L OR ➥ 2 hour glu ≥ 7.8mmol/L NICE 2015 |
| Management | Lifestyle + diet changes. ➥ If CBG target not met, start metformin then ADD insulin if target still not met If metformin contraindicated, OR fasting glu >7, OR fasting glu 6-6.9 AND complications then start insulin ➥ Continuous glucose monitoring not routine ➥ Watch out for ketones/hyperglycaemia ➥ ACR > 200 → watch ➥ Target: fasting glucose 5.3; post-prandial 1h 7.8, 2h 6.4 ➥ ↑ risk DM afterward |