Endocrine Society releases new guidelines on diabetes, pregnancy

Blumer I. Diabetes Care. 2013;doi:10.1210/jc.2013-2465.

  • November 6, 2013

An Endocrine Society-appointed task force has released new clinical practice guidelines for the management of patients with diabetes who are looking to conceive and all pregnant patients in relation to diabetes risk, according to a press release.

This evidence-based approach addresses clinical implications in the contemporary management of women with type 1 or type 2 diabetes before conception, during pregnancy and in postpartum. All pregnant women who have not been diagnosed with diabetes should be tested for the disease at their first prenatal visit, according to the press release.

“Many women have type 2 diabetes but may not know it,” Ian Blumer, MD, of the Charles H. Best Diabetes Centre in Whitby, Ontario, Canada, and chair of the task force, said in a press release. “Because untreated diabetes can harm both the pregnant woman and the fetus, it is important that testing for diabetes be done early on in pregnancy so that, if diabetes is found, appropriate steps can be immediately undertaken to keep both the woman and her fetus healthy.”

Ian Blumer, MD 

Ian Blumer

The task force said clinicians should use lower blood glucose levels to diagnose gestational diabetes to detect the disease as soon as possible.

Some of the other recommendations highlighted in the press release and clinical practice guidelines include:

  • All pregnant women who have not previously been diagnosed with diabetes should be tested for gestational diabetes by having an oral glucose tolerance test performed at 24 to 28 weeks gestation.
  • Weight loss is recommended prior to pregnancy for women with diabetes who are overweight or obese.
  • Initial treatment of gestational diabetes should be medical nutrition therapy and daily moderate exercise lasting at least 30 minutes.
  • If lifestyle therapy is not sufficient to control gestational diabetes, blood glucose-lowering medication should be added.
  • Women with gestational diabetes should have an OGTT 6 to 12 weeks after delivery to rule out prediabetes or diabetes.
  • Women who have had gestational diabetes with a previous pregnancy must be tested for diabetes regularly, especially before any future pregnancies.
  • Women who have type 1 or type 2 diabetes should undergo a detailed eye exam to check for diabetic retinopathy and, if damage to the retina is found, have treatment before conceiving.

Disclosure: Blumer reports financial or business ties with AstraZeneca, Bayer, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen Pharmaceuticals, Medtronic, Novo Nordisk, Roche, Sanofi-Aventis and Takeda. See the paper for a full list of disclosures.

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