I'm sure many of you have read or heard that there are new thrsholds for gestational diabetes called for by an international consensus panel. 
The new criteria use a single mesurement of fasting plasma glucose of 92 mg/dL or higher or a glucose tolerance test of 180 mg/dL at one hour or 153 mg/dL at two hours. 
In the US, this new criteria is small compared to current diagnostic criteria used by the American Diabetes Association.  The ADA diagnostic thresholds are fasting glucose of 95 mg/dL, 180 mg/dL for a 100-mg glocose tolerance test at one hour and 155 mg/dL at two hours. 
The article I read stated that 5-8% of pregnant women in the US receive a gestational diabetes diagnosis.
It also noted that in the International Hyperglycemia and Adverse Pregnancy Outcome (HAPO) trial, up to 16.1% of pregnant women met at least one of the new criteria. 
The HAPO trial formed the basis for the new criteria.  The trial noted that at the thresholds set, the risk was doubled for a large-for-gestational-age baby, preeclampsia, and toxemia. 
It also stated that trials have shown that treating mild gestational diabetes effectively reduced many of these risk with some women needing little more than lifestyle changes. 
The ADA has not adopted the new recommendations but is evaluating them. 
Do you think the new criteria should be adopted or do you think the criteria currently in use by the ADA is sufficient?
Are physicians and health care workers in your area of practice actively addressing GDM?  If not, why do you think that is?  If so, what are they doing right?
If you are practicing outside of the US, what criteria are used for diagnosing GDM where you practice?  Is GDM addressed appropriately?

Micki,
the physicians whom refer to us for Gestational Diabetes consults are way behind the times. They generally give us a referral that says, "GDM 2000cal ADA diet". Amazing isn't it? So the new guidelines will only confuse them more. On a few occasions, we get a referral for "nutrition consult no ADA diet" if on value of the OGTT is elevated. This has happened even if the one value was very high and all the others below threshhold. This is frustrating to us because to us, there is definitely an impairment beyond normal pregnancy insulin resistance. Maybe the new guidelines will give us more of a voice, but based on the pushback we have received on basic issues (ketone testing, qid blood glucose monitoring and OHA recommendations), they won't  nibble on it.
I will most certainly send the new research on and hope for the best. I am interested to hear how the new criteria will affect others' practices?

I'm all for diagnosing GDM earlier, and then of course making sure the women get the necessary education and treatment in order to have a healthy pregnancy. It might also be an earlier wake up call for women who then have increased risk of developing type 2 later on.

Our practice has never tracked the number of women with GDM who are referred to us for comprehensive education. This discussion makes me think it would be interesting to get some statistics on this in our hospital, but I'm not sure where to start. Has anyone looked into this type of data in your area?

All -

There's two streams of conversation on this topic...read this stream and then consider reading http://www.presentdiabetes.com/etalk/Recommendations-for-revised-t1924.html

While this conversation is about more stringent classification of GDM, picking up GDM or what really is overt/pre-existing type 2 (most often) as early as possible in the pregnancy...another area where a lot of work is needed is better detection, management and follow up of woman who have had GDM. With the figure of about 50% of women who have had GDM converting sometime in the future to type 2, this is such a prime population for immediate efforts to prevent prediabetes, type 2.

Do people know of/have successful programs working with woman at high risk of type 2 post GDM?

Thanks,

Hope Warshaw, MMSc, RD, CDE

Nutrition Section Editor, www. PRESENTdiabetes.com

I have had a "rash" of young women sent to me who really needed to be sent to high risk OB.  I work in an outpatient diabetes managment clinic.  We adjust insulin dosing and educate patients on DM managment.  Lately, I have had physicians sending me patients with uncontrolled type 1 diabetes who are pregnant.  I appreciate their confidence in my abilities but I immediately let the referring physician know that the patient needs to be seen at the high risk OB clinic.  I will see them in the meantime but we usually get them over to high risk OB rather quickly. 
I have seen a few GDM patients here and worked with them on meal planning and monitoring.  What I have found is that my recommendations for them to check 1 hr pp BGs differs from the high risk OB group, who suggest the patient check 2 hr pp BGs.  The high risk group also has looser BG goals for GDM patients.  In that case, I turn the case over to them.  I figure, they are the high risk "experts" and I am not.  But it concerns me that their BG goals are looser than mine.  I tried to call and email the nurse there to talk about their goals but have gotten no response. 
The goals I use for GDM are fasting 60-100; 1 hr pp 110-140; 2 hr pp <120.
In response to this thread, I previously worked in diabetes education only clinic (no mangement).  We had a physician who sent us GDM patients for meal planning who wanted them on low calorie diets.  The recommendations re: calorie level were inappropriate and potentially dangerous for the pregnant women.  We had to refuse to see patients from that physician because they would not follow our recommendations.  I could not in good conscience simply follow the physicians orders.
MH