Monday, January 23, 2017

Step 2 CK: Screening for Gestational Diabetes Mellitus (GDM)


As you guys already know, GDM diagnosis can be accomplished with either of two strategies:
“One-step” 75-g OGTT or “Two-step” approach with a 50-g (nonfasting) screen followed by a 100-g OGTT for those who screen positive.

But what if, in the exam, you are asked to choose a screening test for GDM...
And the options contain both:
- One hour 50 gram glucose load test (1-h 50-g GLT)
- Two hour 75 gram oral glucose tolerance test (2-h 75-g GTT)
... Then which one do you choose?

Choose the 1-h 50-g GLT. 


- Screening with a 50-g GLT does not require fasting and is therefore easier to accomplish for many women.

- Treatment of higher threshold maternal hyperglycemia, as identified by the two-step approach, reduces rates of neonatal macrosomia, LGA, and shoulder dystocia, without increasing small-for-gestational-age births.

- Lack of clinical trial interventions demonstrating the benefits of the “one-step” strategy.

- The potential negative consequences of identifying a large new group of women with GDM.

Source: American Diabetes Association Diabetes Care 2017 Jan

When do you screen for GDM?
Test for gestational diabetes mellitus at 24–28 weeks of gestation in pregnant women not previously known to have diabetes.

That's all!

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