What's new in gdm
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Transcript of What's new in gdm
Scopes
What’s new in GDM?
Our Current Practice
What’s New? Anything we can change?
Our Current Practice
What’s new in GDM?
Terminology
Gestational DM
PregestationalDM
Likely Pregestational
DM
Selective screening of GDM
Wh
en
to
scr
ee
n?
24 – 28 weeks gestation
2 hours75-g
oral glucose tolerance test (OGTT)
16 – 18 weeks gestation if previous history of GDM.
If normal, repeat another one at 24 – 28 weeks gestation
MOH uses Fasting Blood Sugar ≥ 5.6 mmol/L or 2-H Plasma Glucose ≥ 7.8 mmol/L (following 75g oral glucose load) as abnormal MOGTT result.
Diagnosis of GDM
What’s new in GDM?
WHO 1999 used Fasting Blood Sugar ≥ 7.0 mmol/L or 2-H Plasma Glucose ≥ 7.8 mmol/L (following 75g oral glucose load) as abnormal MOGTT result.
How to
treat?
- Diet Control- Insulin
What’s new in GDM?
What’s new?
What’s new in GDM?
Terminology
• FPG ≥ 7.0 mmol/L
• 2HPG ≥ 11.1 mmol/L (75g oral glucose load)
• RPG ≥ 11.0 mmol/L in the presence of diabetes symptoms
DM in Pregnancy
• FPG = 5.1 – 6.9 mmol/L
• 1HPG ≥ 10.0 mmol/L (75g oral glucose load)
• 2HPG = 8.5 – 11.0 mmol/L (75g oral glucose load)
Gestational DM
Diagnostic Criteria & Classification of Hyperglycaemia First Detected in Pregnancy. WHO (2013)
Reduces incidence of macrosomia & hypertensive disorders
UNIVERSAL SCREENING
Diagnostic Criteria & Classification of Hyperglycaemia First Detected in Pregnancy. WHO (2013)
How to
treat?
- Diet Control- Insulin- Oral hypoglcaemic agent
What’s new in GDM?
Oral Hypoglycaemic Agent (OHA)
• Metformin• Well studied in MiG Trial
• 46% will need addition of insulin eventually• FDA Class B, safe in pregnancy• MiG-TOFU: children exposed to metformin had larger measures of
subcutaneous fat
Rowan JA et. al. MiG Trial Investigators. Metformin versus insulin for the treatment of gestational diabetes. N Eng J Med 2008; 358:2003-2015
Oral Hypoglycaemic Agent (OHA)
• Glyburide (glibenclamide)• Relatively safe alternative to insulin therapy• 20% will need addition of insulin eventually• Possible risk of neonatal hypoglycaemia /
hyperbilirubinaemia
Thomas R.M. Glyburide for the Treatment of Gestational Diabetes. A critical appraisal. Diabetes Care 2007; 30(Sup 2):S209-S213
Anything we can change?
What’s new in GDM?
Can we change the practice in
Sarawak?
What’s new in GDM?
Universal Screening
MOGTT values
OHA (metformin,
glibenclamide)
THANKS…THANKS…
