Building Competency in Diabetes Education THE ESSENTIALS

PATHOPHYSIOLOGY| 3-23

• Measurement of insulin, ICAs or GAD antibodies (present in type 1) may be helpful in diagnosing type 1 diabetes, particularly in the adult (17,31), but these tests are not available in all settings. • Treatment may be similar for both type 1 and 2 diabetes, depending on the amount of insulin production.

Other types of diabetes Gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is diabetes first diagnosed in pregnancy. The rate of GDM varies widely, from 3.8% (35) in the general population and 6.4 to 22.8% in the Indigenous population (36). It is often detected in weeks 24 to 28 of pregnancy, when insulin resistance is high. It is often asymptomatic. At the termination of the pregnant state, the woman generally resumes her pre-gestational non-diabetes state. However, once a woman has had GDM, her risk of developing type 2 diabetes later in life is significantly increased. The cumulative risk for type 2 diabetes after GDM is 30 to 60% over 10 years (37,38) (see Chapter 10: Gestational Diabetes Mellitus). An etiologic classification of diabetes mellitus is provided in Appendix 2 of the 2018 Guidelines and includes the following (39): Monogenic diabetes Monogenic diabetes - maturity onset diabetes of the young (MODY) and neonatal diabetes are characterized by a defect in a single gene impacting beta cell function. The diagnosis of monogenic diabetes is achieved through genetic testing in specialized laboratories. Despite the cost of these tests (between $1,950-7,800 for full gene sequencing), it is important to identify these individuals and provide proper therapy with oral antihyperglycemic agents (specifically sulfonylurea) (40). • MODY MODY is characterized by defective insulin secretion with minimal or no defects in insulin action. There are now 11 MODY genetic beta cell defects that have been identified with variation in the degree of hyperglycemia, need for insulin and risk of complications. This is a group of disorders characterized by autosomally dominant inherited (50% of the offspring will have it) early-onset diabetes and beta cell dysfunction (34). It affects people under the age of 30 with a strong family history of diabetes. MODY resembles type 2 in