O&G Update 2014

Hospital Sarikei, Sarawak

yongsoonleong@yahoo.com

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…