what's new in gdm
TRANSCRIPT
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Scopes
What’s new in GDM?
Our Current Practice
What’s New? Anything we can change?
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Our Current Practice
What’s new in GDM?
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Terminology
Gestational DM
PregestationalDM
Likely Pregestational
DM
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Selective screening of GDM
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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
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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.
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How to
treat?
- Diet Control- Insulin
What’s new in GDM?
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What’s new?
What’s new in GDM?
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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)
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Reduces incidence of macrosomia & hypertensive disorders
UNIVERSAL SCREENING
Diagnostic Criteria & Classification of Hyperglycaemia First Detected in Pregnancy. WHO (2013)
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How to
treat?
- Diet Control- Insulin- Oral hypoglcaemic agent
What’s new in GDM?
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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
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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
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Anything we can change?
What’s new in GDM?
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Can we change the practice in
Sarawak?
What’s new in GDM?
Universal Screening
MOGTT values
OHA (metformin,
glibenclamide)
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THANKS…THANKS…