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P OSITION S TATEMENT ABCD position statement on screening for gestational diabetes mellitus Pract Diab Int May 2007 Vol. 24 No. 4 Copyright © 2007 John Wiley & Sons 195 sion to T2DM. 17 Ideally, all mothers following a GDM pregnancy should have a six weeks’ fasting plasma glu- cose to ensure they do not have T2DM; thereafter they should be screened annually for T2DM in primary care. At the time of this annual screening, lifestyle advice for the prevention of T2DM should be reinforced. Conclusion Gestational diabetes mellitus is a cause of morbidity for the mother and her child and is associated with an increased perinatal mortality rate. The optimum screening policy for an antenatal clinic should vary according to the background preva- lence of GDM and T2DM. The pre- cise level of glycaemia that predicts adverse outcome is not known. On present evidence, a two-hour glucose level in a 75g OGTT >7.8mmol/L benefits from active treatment. We believe diabetes should be actively sought and treated in pregnancy and that the original 2003 NICE ante- natal recommendations not to rou- tinely screen are now out dated. We offer a pragmatic approach for the detection of glucose intolerance in pregnancy as we await the NICE 2007 review of the original 2003 NICE antenatal recommendations. Conflict of interest statement There are no conflicts of interest. References 1. World Health Organization, Depart- ment of Noncommunicable Disease Surveillance. Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO consul- tation. Part 1: diagnosis and classifica- tion of diabetes mellitus. Geneva: World Health Organization, 1999. 2. O’Sullivan JB. Body weight and sub- sequent diabetes mellitus. JAMA 1982; 248(8): 949–952. 3. Dornhorst A, Paterson CM, Nicholls JS, et al. High prevalence of gesta- tional diabetes in women from ethnic minority groups. Diabetic Med 1992; 9(9): 820–825. 4. Pederson J, Bojsen-Moller B, Poulsen H. Blood sugar in newborn infants of diabetic mothers. Acta Endocrinologica 1954; 15: 33–52. 5. Maresh M, Beard RW, Bray CS, et al. Factors predisposing to and outcome of gestational diabetes. Obstet Gynecol 1989; 74(3 Pt 1): 342–346. 6. NICE recommendations. Antenatal care for the healthy pregnant woman. http://www.rcog.org.uk/resources/ Public/Antenatal_Care.pdf 7. Marquette GP, Klein VR, Niebyl JR. Efficacy of screening for gestational diabetes. Am J Perinatology 1985; 2: 7–9. 8. Carpenter MW, Coustan DR. Criteria for screening tests for gestational dia- betes. Am J Obstet Gynecol 1982; 144(7): 768–773. 9. Report on gestational diabetes melli- tus. Diabetes Care 2004; 27(Suppl 1): S88–S90. 10. Crowther CA, Hilier J, Moss J, et al. Effect of treatment of gestational dia- betes mellitus on pregnancy out- comes. N Engl J Med 2005; 352: 2477–2486. 11. HAPO Study Cooperative Research Group. The Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study. Int J Gynaecol Obstet 2002; 78: 69–77. 12. Major CA, Henry MJ, De Veciana M, et al. The effects of carbohydrate restriction in patients with diet con- trolled gestational diabetes. Obstet Gynecol 1998; 91: 600–604. 13.De Veciana M, Major CA, Morgan MA, et al. Postprandial versus preprandial blood glucose monitor- ing in women with gestational dia- betes mellitus requiring insulin ther- apy. N Engl J Med 1995; 333: 1237–1241. 14. Masson EA, Patmore JE, Brash PD, et al. Pregnancy outcome in type I dia- betes mellitus treated with insulin therapy (Humalog). Diabetic Med 2003; 20: 46–50. 15. Langer O, Conway DL, Berkus MD, et al. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med 2000; 343: 1134–1138. 16. Hughes RC, Rowan JA. Pregnancy in women with type II diabetes: who takes Metformin and what is the out- come? Diabetic Med 2006; 23: 318–322. 17. Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or met- formin. N Engl J Med 2002; 346: 393–403. RCN Paediatric and Adolescent Diabetes Group The Paediatric and Adolescent Diabetes Special Interest Group would like to draw readers’ attention to the recent launch (on 5 April) of the Department of Health report ‘Making Every Young Person with Diabetes Matter’. Members of the PADSIG were part of the working group that was set up in 2005. The report sets out the findings from the working group that were established to examine the current challenges and seek solutions to them. The report is aimed at everyone who has a part to play in improving services for children and young people with diabetes up to the age of 25. This includes commis- sioners and health professionals. The report provides guidance and makes recommendations in a number of areas, including commissioning, organisation of care, provision of serv- ices and workforce. This report is a must for all members of the diabetes service who are involved in providing diabetes care for children, young people and their families. To obtain copies of the report please e-mail: [email protected]. Report by Marie Marshall, Paediatric Diabetes Nurse Specialist, and Publicity Officer, RCN Paediatric and Adolescent Diabetes Special Interest Group The Royal College of Nursing: The Voice of Nursing 20 Cavendish Square, London W1M 0AB. Tel: 020 7409 3333 Fax: 020 7647 3435 ROYAL COLLEGE OF NURSING RCN News

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POSITION STATEMENT

ABCD position statement on screening for gestational diabetes mellitus

Pract Diab Int May 2007 Vol. 24 No. 4 Copyright © 2007 John Wiley & Sons 195

sion to T2DM.17 Ideally, all mothersfollowing a GDM pregnancy shouldhave a six weeks’ fasting plasma glu-cose to ensure they do not haveT2DM; thereafter they should bescreened annually for T2DM in primary care. At the time of thisannual screening, lifestyle advice forthe prevention of T2DM should bereinforced.

ConclusionGestational diabetes mellitus is acause of morbidity for the motherand her child and is associated withan increased perinatal mortality rate.The optimum screening policy foran antenatal clinic should varyaccording to the background preva-lence of GDM and T2DM. The pre-cise level of glycaemia that predictsadverse outcome is not known. Onpresent evidence, a two-hour glucoselevel in a 75g OGTT >7.8mmol/Lbenefits from active treatment. Webelieve diabetes should be activelysought and treated in pregnancy andthat the original 2003 NICE ante-natal recommendations not to rou-tinely screen are now out dated. Weoffer a pragmatic approach for thedetection of glucose intolerance inpregnancy as we await the NICE 2007review of the original 2003 NICEantenatal recommendations.

Conflict of interest statementThere are no conflicts of interest.

References 1. World Health Organization, Depart-

ment of Noncommunicable DiseaseSurveillance. Definition, diagnosis andclassification of diabetes mellitus and itscomplications. Report of a WHO consul-tation. Part 1: diagnosis and classifica-tion of diabetes mellitus. Geneva: WorldHealth Organization, 1999.

2. O’Sullivan JB. Body weight and sub-sequent diabetes mellitus. JAMA1982; 248(8): 949–952.

3. Dornhorst A, Paterson CM, NichollsJS, et al. High prevalence of gesta-tional diabetes in women from ethnicminority groups. Diabetic Med 1992;9(9): 820–825.

4. Pederson J, Bojsen-Moller B, PoulsenH. Blood sugar in newborn infants ofdiabetic mothers. Acta Endocrinologica1954; 15: 33–52.

5. Maresh M, Beard RW, Bray CS, et al.Factors predisposing to and outcomeof gestational diabetes. Obstet Gynecol1989; 74(3 Pt 1): 342–346.

6. NICE recommendations. Antenatalcare for the healthy pregnant woman.http://www.rcog.org.uk/resources/Public/Antenatal_Care.pdf

7. Marquette GP, Klein VR, Niebyl JR.Efficacy of screening for gestationaldiabetes. Am J Perinatology 1985; 2:7–9.

8. Carpenter MW, Coustan DR. Criteriafor screening tests for gestational dia-betes. Am J Obstet Gynecol 1982;144(7): 768–773.

9. Report on gestational diabetes melli-tus. Diabetes Care 2004; 27(Suppl 1):S88–S90.

10.Crowther CA, Hilier J, Moss J, et al.Effect of treatment of gestational dia-

betes mellitus on pregnancy out-comes. N Engl J Med 2005; 352:2477–2486.

11.HAPO Study Cooperative ResearchGroup. The Hyperglycaemia andAdverse Pregnancy Outcome(HAPO) Study. Int J Gynaecol Obstet2002; 78: 69–77.

12.Major CA, Henry MJ, De Veciana M,et al. The effects of carbohydraterestriction in patients with diet con-trolled gestational diabetes. ObstetGynecol 1998; 91: 600–604.

13.De Veciana M, Major CA, MorganMA, et al. Postprandial versuspreprandial blood glucose monitor-ing in women with gestational dia-betes mellitus requiring insulin ther-apy. N Engl J Med 1995; 333:1237–1241.

14.Masson EA, Patmore JE, Brash PD, etal. Pregnancy outcome in type I dia-betes mellitus treated with insulintherapy (Humalog). Diabetic Med2003; 20: 46–50.

15.Langer O, Conway DL, Berkus MD, etal. A comparison of glyburide andinsulin in women with gestationaldiabetes mellitus. N Engl J Med 2000;343: 1134–1138.

16.Hughes RC, Rowan JA. Pregnancy inwomen with type II diabetes: whotakes Metformin and what is the out-come? Diabetic Med 2006; 23:318–322.

17.Knowler WC, Barrett-Connor E,Fowler SE, et al; Diabetes PreventionProgram Research Group. Reductionin the incidence of type 2 diabeteswith lifestyle intervention or met-formin. N Engl J Med 2002; 346:393–403.

RCN Paediatricand AdolescentDiabetes GroupThe Paediatric and Adolescent DiabetesSpecial Interest Group would like todraw readers’ attention to the recentlaunch (on 5 April) of the Departmentof Health report ‘Making Every YoungPerson with Diabetes Matter’. Membersof the PADSIG were part of the workinggroup that was set up in 2005. Thereport sets out the findings from the

working group that were established toexamine the current challenges andseek solutions to them. The report isaimed at everyone who has a part toplay in improving services for childrenand young people with diabetes up tothe age of 25. This includes commis-sioners and health professionals.

The report provides guidance andmakes recommendations in a numberof areas, including commissioning,organisation of care, provision of serv-ices and workforce.

This report is a must for all membersof the diabetes service who are involved

in providing diabetes care for children,young people and their families.

To obtain copies of the reportplease e-mail: [email protected].

Report by Marie Marshall, PaediatricDiabetes Nurse Specialist, and PublicityOfficer, RCN Paediatric and AdolescentDiabetes Special Interest Group

The Royal College of Nursing:The Voice of Nursing20 Cavendish Square, London W1M 0AB. Tel: 020 7409 3333 Fax: 020 7647 3435

ROYAL

COLLEGE OF

NURSING

RCN News

PS Robinson 10.07.qxp 23/4/07 17:25 Page 5