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  #1  
Old 10-18-2011
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ObGyn Management of gestational diabetes

A 29-year-old woman comes to your office for follow-up of hypothyroidism and gestational diabetes. She had a vaginal delivery 10 weeks ago, and during pregnancy her thyroxine was increased. She also had gestational diabetes during pregnancy, which was diagnosed with a 28-week glucose tolerance test. She was managed with insulin during the pregnancy. She failed to keep her postpartum appointment with her obstetrician. Which of the following is the most appropriate management, given this patient’s history of gestational diabetes?

A. 75-g, 2-hour oral glucose tolerance test
B. No medication or testing is needed
C. Start glyburide treatment
D. Start insulin treatment
E. Start metformin treatment
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Old 10-19-2011
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Hmmm OBGYN is not fresh in my memory but I will go for some kind of glucose testing first (so A) then if she is still diabetic, initial drug of choice will be metformin (choice E).

Noy very sure though
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Old 10-19-2011
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my mind just clicking at > A. 75-g, 2-hour oral glucose tolerance test
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Old 10-19-2011
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B. No medication or testing is needed
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Old 10-19-2011
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Correct Answer Answer

The correct answer is A. Gestational diabetes is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. Reported prevalence in the United States ranges from 2 to 5%. However, the prevalence varies tremendously on the basis of specific population or ethnic group studied. Women with gestational diabetes have an increased risk of developing the hypertensive disorders of pregnancy. Offspring of women with gestational diabetes have increased rates of macrosomia and hyperbilirubinemia. Most relevant to this patient, women with gestational diabetes are at high risk of developing overt diabetes later in life. Estimates are that as many as 50% of women with gestational diabetes will go on to eventually develop overt diabetes mellitus, compared with only 7% of women who do not have gestational diabetes. To detect those women who may have overt diabetes, the American College of Obstetricians and Gynecologists recommends that women with gestational diabetes undergo a 75-g, 2-hour oral glucose tolerance test (OGTT) at the 6-week postpartum visit. This patient missed her postpartum visit; therefore, it would be appropriate to perform the OGTT at this time to detect whether or not this patient has diabetes mellitus, impaired fasting glucose, or impaired glucose tolerance.
Stating that no medication or testing is needed (choice B) is incorrect. This patient had gestational diabetes during her most recent pregnancy. She missed her postpartum visit. She should, therefore, have an OGTT to determine whether or not she has diabetes.
Starting glyburide treatment (choice C), insulin treatment (choice D), or metformin treatment (choice E) would not be correct at this time. All of these medications can be used to treat patients with diabetes. Patients with gestational diabetes are most often treated with insulin during the pregnancy because oral antidiabetic agents are still considered to be experimental. This patient is no longer pregnant, so these drugs could be prescribed. However, it is important to note that she has not been diagnosed with diabetes. She did have gestational diabetes, but it is not clear at this time whether she has diabetes mellitus. Therefore, the 75-g, 2-hour glucose tolerance test should be given to this patient first. If she is found to have diabetes mellitus, then a treatment regimen can be selected.
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  #6  
Old 10-19-2011
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Testing makes sense.

Just curious, where are these questions coming from?
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