ADIPS - Information

The ADIPS Gestational Diabetes Management Guidelines were published in 1998 in the Medical Journal of Australia (Vol 169, 93-97). These were determined by consensus after widespread discussion by the ADIPS membership between 1991 and 1998. The key recommendations are:

Universal screening for gestational diabetes is recommended, but where resources are limited, or in areas of low incidence, then selective screening based on risk factors may be appropriate.
Screening should be performed at 26-28 weeks gestation. Positive results are a venous plasma glucose level of >= 7.8 mmol/l 1 hour after a 50g glucose load (morning, non-fasting), or a level of >= 8.0 mmol/ after a 75g glucose load.
Confirmation of diagnosis is by a 75g oral glucose tolerance test. A venous plasma glucose >= 5.5 mmol/l fasting, and/or >= 8.0 mmol/l (>= 9.0 mmol/l in New Zealand) after 2 hours, is a positive result.
Patient education and a team approach are important.
Blood glucose targets are fasting < 5.5 mmol/l, 1 hour postprandial < 8.0 mmol/l or 2 hour postprandial < 7.0 mmol/l.
Diet is the primary therapeutic strategy, but insulin may be required to achieve targets.
Antepartum foetal surveillance is essential. Continuation of an uncomplicated GDM pregnancy to 10 days beyond term is acceptable if indications from foetal monitoring are reassuring.
Close neonatal monitoring is important, especially for hypoglycaemia.
Maternal follow-up with an oral glucose tolerance test should be performed after 6-8 weeks. Subsequent screening for diabetes is recommended at least second yearly.
Prospective trials are needed to determine whether universal screening is justified, and to determine the degree of maternal hyperglycaemia that causes adverse outcomes.
For the full article go to http://www.mja.com.au/public/issues/jul20/hoffman/hoffman.html