Building Competency in Diabetes Education THE ESSENTIALS

PATHOPHYSIOLOGY| 3-33

o Member of high-risk ethnic group (e.g. Aboriginal, African, Arab, Asian, Hispanic or South Asian descent) [ Grade D, Level 4]. o Family history of type 2 diabetes in a first degree relative and/or exposure to diabetes in utero [ Grade D, Level 4]. o Signs or symptoms of insulin resistance (including acanthosis nigricans, hypertension, dyslipidemia, non-alcoholic fatty liver disease [ALT >3x upper limit of normal or fatty liver on ultrasound], PCOS) [ Grade D, Level 4] • Impaired fasting glucose or impaired glucose tolerance [ Grade D, Consensus ]. • Use of antipsychotic medications [ Grade D, Consensus ]. Current guidelines recommend screening for diabetes in elderly with both FBG and A1C. Gestational diabetes The 2018 Guidelines acknowledge that there is some international controversy in the diagnostic criteria that will predict adverse outcomes in pregnancy. However, the 2018 Guidelines recommend that all pregnant women should be screened for GDM between 24 and 28 weeks gestation (45). Screening is recommended at any stage of the pregnancy if there is a high risk of GDM based on multiple risk factors. The preferred approach is 50 g glucose load followed by a plasma glucose (PG) test measured one hour later. Women with a positive screening test (one-hour PG of 7.8 to 11.0 mmol/L) should have a 75 g OGTT. A gestational diabetes screen of ≥11.1 mmol/L is cons idered diagnostic of GDM, in which case an OGTT is not necessary. If one of the OGTT results is met or exceeded, it confirms a diagnosis of GDM. Follow-up screening with a 75 g OGTT six weeks to six months postpartum is essential to identify abnormal glucose levels (45). Evidence suggests that any dysglycemia during pregnancy increases the risk of developing diabetes (46). In Ontario, Feig et al. showed that about 20% of women with prior GDM will develop type 2 diabetes in nine years (38).