Gestational diabetes mellitus (GDM) is defined as glucose intolerance first discovered in pregnancy. Pregestational diabetes mellitus refers to any type of diabetes diagnosed before pregnancy. Pregnant women with pregestational diabetes experience an increased risk of poor maternal, fetal, and neonatal outcomes. The extent to which GDM predicts adverse outcomes for mother, fetus, and neonate is less clear. Depending on the diagnostic criteria used and the population screened, the prevalence of GDM ranges from 1.1 to 25.5 percent of pregnancies in the United States. The incidence of GDM has increased over the past decades in parallel with the increase in rates of obesity and type 2 diabetes mellitus, and this trend is expected to continue. It is unclear how much the increase in obesity will affect the proportion of women diagnosed with overt diabetes during pregnancy versus transient pregnancy-induced glucose intolerance. GDM is usually diagnosed after 20 weeks’ gestation when placental hormones that have the opposite effect of insulin on glucose metabolism increase substantially. Women with adequate insulin secreting capacity overcome this insulin resistance of pregnancy by secreting more endogenous insulin to maintain normal blood glucose. Women with less adequate pancreatic reserve are unable to produce sufficient insulin to overcome the increase in insulin resistance, and glucose intolerance results. Glucose abnormalities in women with GDM usually resolve postpartum, but commonly recur in subsequent pregnancies. Women with GDM have an increased risk of future development of overt diabetes. The cumulative incidence of diabetes after a diagnosis of GDM varies widely depending on maternal body mass index (BMI), ethnicity, and time since index pregnancy, and it may reach levels as high as 60 percent. When glucose abnormalities persist postpartum in a woman with GDM, her diabetes is recategorized as overt diabetes. When this occurs, the likelihood that this woman had pregestational (i.e., overt) diabetes increases, especially if the diagnosis of GDM occurred before 20 weeks’ gestation and glucose levels were markedly elevated in pregnancy. Based on systematic reviews published in 2003 and 2008, the USPSTF concluded that there was insufficient evidence upon which to make a recommendation regarding routine screening of all pregnant women for GDM. The primary aims of this review were to (1) identify the test properties of screening and diagnostic tests for GDM, (2) evaluate the potential benefits and harms of screening at greater than or equal to 24 weeks and less than 24 weeks’ gestation, (3) assess the effects of different screening and diagnostic thresholds on outcomes for mothers and their offspring, and (4) determine the effects of treatment in modifying outcomes for women diagnosed with GDM. The benefits and harms of treatments were considered in this review to determine the downstream effects of screening on health outcomes. The intent of this review was also to assess whether evidence gaps in the previous USPSTF reviews have been filled. Key questions include: Key Question 1: What are the sensitivities, specificities, reliabilities, and yields of current screening tests for GDM? (a) After 24 weeks’ gestation? (b) During the first trimester and up to 24 weeks’ gestation? Key Question 2: What is the direct evidence on the benefits and harms of screening women (before and after 24 weeks’ gestation) for GDM to reduce maternal, fetal, and infant morbidity and mortality? Key Question 3: In the absence of treatment, how do health outcomes of mothers who meet various criteria for GDM and their offspring compare to those who do not meet the various criteria? Key Question 4: Does treatment modify the health outcomes of mothers who meet various criteria for GDM and their offspring? Key Question 5: What are the harms of treating GDM and do they vary by diagnostic approach?
Type I diabetes (also called insulin – dependent diabetes mellitus, or IDDM) takes place whenever the pancreatic cells in the do not do its work and they produce less than the needed insulin. If the pancreas does not even make insulin, the sugar cannot be utilized by the tissues.
To stay alive, the majority of these people will have to depend on insulin injections for the rest of their lives. Type I is the much less common form of diabetes — only about 10 – 20 per cent of all diabetics are insulin – dependent. This kind of diabetes usually begins in childhood or youth.
Type II diabetes (also called non – insulin – dependent diabetes mellitus, or NIDDM) usually occurs in overweight individuals who are beyond the age of 40. In Type II diabetes, the pancreas does still produce some insulin. There are instances that the body is simply not making enough insulin. In other instances, though, the pancreatic cells are producing normal levels of insulin, but that insulin is no longer useable since the cells’ insulin receptors — the “locks” — are shut closed. The pancreatic cells react to this scenario by making lots and lots of insulin. But when the receptors are not functional, even this cannot remedy it.
- Diabetic Glucose Test Screening for Sugar Levels in Urine.
- Results in 1 minute. Fast & Convenient. Accurate results every time.
- Simply follow the instruction sheet inside, wait 30-60 seconds for results to show. Then compare the test strip with the result chart to see what your sugar level is at the time.
- Compare to National Brands
- English and Spanish Instructions inside.
This study aimed to investigate the cut-off value of glucose challenge test (GCT) for screening Gestational Diabetes Mellitus (GDM) in a Bangladeshi population. A total of 224 Bangladeshi pregnant women who underwent a GCT were prospectively investigated. GCT was performed between 24 to 28 weeks of gestation. Women demonstrating GCT exceeding 130 mg/dl (>7.2mmol/l) received a 75 g, 2 hr oral glucose tolerance test to determine whether or not they had GDM. Twenty three (10.3%) women were diagnosed to have GDM. The receiver-operator characteristics curve identified a GCT finding above 174 mg/dl as the cut-off value for detecting GDM, which showed sensitivity, specificity, PPV and NPV of 35%, 90%, 80% and 68% respectively. Based on PPV and NPV, our data suggest that 1 hr-50g GCT is a feasible and acceptable screening test and a cut-off value of 174 mg/dl, as the post-challenge serum glucose, may be appropriate for screening GDM in Bangladeshi population by this test.
This book is divided into two main sections, and covers a broad range of issues important for health practitioners to be aware of when caring for people with co-morbid diabetes and depression. Section One of the book contains the overall ideas and the more recent developments in measuring psychological morbidity in people with diabetes. When attempting to identify people with depression or other psychological problems, it is important for practitioners to recognize the limitations of screening as well as its utility. Issues such as the basic principles regarding when and when not to screen, the cultural applicability of tools, different questionnaire formats and key concepts such as sensitivity and specificity of tools, and their positive and negative predictive value, will be considered. In particular there has been increased interest in the concept of diabetes-related distress and several tools have been developed to measure this. There are broad-based measures of distress such as the Problem Areas in Diabetes (PAID) scale, the Diabetes Adjustment Scale (DAS), The Diabetes Health Profile, The Fear of Hypoglycemia Scale, etc. There are also a range of generic quality of life tools which have been used effectively in people with diabetes; for example the Medical Outcomes Survey Short-Forms (SF36, SF12), the World Health Organisation Well-being questionnaire (WHO-5) and the EQ5-D. These tools are important because they measure aspects of psychological well-being that are specifically associated with the experience of having a long-term conditions and so have important implications for both self-care and health care practice. The potential overlap of symptoms of depression and symptoms of diabetes-related distress are considered in this section and the implications for practice discussed. Section Two covers the most commonly used tools that have been used to screen for depression. For each tool considered some information which is easily referred to by the readeris set out in a table which includes details of the authors, time of first use, country where it was first developed, some examples of the questions used, the languages it is available in, data on sensitivity/specificity. Each instrument will then be discussed in terms of its use in research as well as practice, and its applicability in different patient groups, different cultural settings and so on. Guidance on the practical use of each tool is included, and the most popular depression screening tools are focussed on.
Beginning with chapters summarizing the basics of diabetic retinopathy, this updated volume outlines the need for screening, how to screen safely and correctly, and the normal condition of the retina without diabetic retinopathy, all using excellent line and halftone illustrations. The core focus then moves on to examining each different form of retinopathy, all supported by outstanding color retinal photographs illustrating the appearance of the retina at various stages of retinopathy, plus an analysis on the best treatment for each stage. The book ends with chapters providing self-assessment questions of the type that screeners will encounter when gaining their now mandatory retinal screening qualifications, as well as a background information chapter offering advice on related UK, European, and US organizations. A website contains all the full-color retinopathy images from the book, with the option to download these into presentations.
Current guidelines state that 100% of patients with diabetes should be screened for retinal problems. This pocketbook is a concise companion for professionals involved in sreening and treating diabetic retinopathy (DR). It explains why screening is required, the different screening models available with their advantages and disadvantages, and the different DR grades. The book also describes specific problems such as ophthalmic lesions, which may present themselves as DR and covers the treatment of DR from both a medical and an ocular perspective.
This book is presented in full color and contains over 100 images. Each chapter is written with a specfic role in a DR screening scheme.
This digital document is an article from Clinical Psychiatry News, published by International Medical News Group on May 1, 2004. The length of the article is 820 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser.
Title: Early screening needed to detect diabetic neuropathy.(Across Specialties)
Author: Damian McNamara
Publication: Clinical Psychiatry News (Magazine/Journal)
Date: May 1, 2004
Publisher: International Medical News Group
Volume: 32 Issue: 5 Page: 99(1)
Distributed by Thomson Gale
The Neuropen is the only dual function screening device with replaceable monofilaments. Peripheral neuropathy cannot be excluded without regular foot screening in conjunction with symptomatic and clinical assessments. Neuropen is an effective aid to this screening programme, meeting and exceeding current practices by being the first dual purpose, pocket size device designed to provide a safe and reliable test. Dual Purpose Neuropen Features: Neurotip test for assessing reduced sensation to sharpness/ pain in small nerve fibres. The calibrated spring mechanism exerts a force of 40g to help assess patients. Monofilament test for assessing protective touch/pressure sensation in large nerve fibres. Kit Includes: Neuropen. 1 10g Monofilament. 1 Neurotip. The product referenced on this detail page is sold be Each.