Screening and Diagnosis of

Diabetes Mellitus during

Pregnancy Prof Recep Has

Istanbul University

ObampGyn and Perinatology

Controversies in Gestational Diabetes

bull Screen or not

bull Selective or universal screening

bull One or two step testing

bull Criteria for diagnosis

bull Criteria for the use of insulin

bull Role of oral hypoglycaemic drugs

Diabetes in Pregnancy

bull Prevalence 3-14

bull Predisposition to Type 2

DM

ndash 50 gt type 2 DM

bull Recurrence in future

pregnancies 30-84

Gestational diabetes

Diabetes diagnosed first time

in pregnancy

bull15-20 pregestational

bullMore complications

bullScreening at first visit (B) Albrecht SS 2010

Diabetes in Pregnancy

Epidemiology

Albrecht SS 2010

Diabetes in Pregnancy 6-7

of GDM 90

O Total

GDM

Type 2

Type 1

Hyperglicemia

Shoulder dystocia

LGA

Why Diagnose and Treat GDM

Mother Fetus Newborn Childhood

Addult

Dystosia Macrosomia RDS Obesity

CS Shoulder dystocia

and nerve injury

Hypoglicemia Type II diabetes

Preeclampsia Cardiomyopathy Hypocalcemia Metabolic

syndrome

Type II diabetes Preterm delivery Hyperbilirubinemia

Metabolic

syndrome

Policytemia

What happened in recent years with

gestational diabetes

bull Studies showed thatndash mild hyperglicemia have adverse effects on pregnancy results

ndash and treatment is beneficial

bull One step screening with 75 gr OGTT is recommended(IADPSG)

bull Oral antidiabetics are in use

Studies

bull HAPO Hyperglycemia and adverse pregnancy outcomesndash HAPO Study N Engl J Med 20083581991

bull ACHOIS Effect of treatment of gestational diabetes mellitus on pregnancy outcomesndash Crowther CA et al N Engl J Med 20053522477

bull MFMUN A Multicenter Randomized Trial of Treatment for Mild Gestational Diabetesndash Landon MB et al N Engl J Med 20093611339

HAPO

ndash NEJM 2008

ndash Prospective blinded

ndash Multicenter different etnic groups

bull 25505 women

bull 24 ndash 32 w 75 gr GTT

ndash Exclusion

Fasting gt105 mgdL or

2 h ge200 mgdL or

Random ge160 mgdL

bull Aim

ndash To investigate maternal mild

hyperglicemia related

pregnancy risks

bull Fasting glucose levels divided 7 groups (5 mgdl intervals)

HAPO Incidence of Adverse Outcomes

Increases Along Continuum

Metzger BE et al Hyperglycemia and Adverse Pregnancy Outcomes NEJM 2008358(19)1991-2002

HAPO-Result

bull With increasing glocose

levelsndash Birth weight

ndash Cord C-Peptid levels

ndash CS

ndash Neonatal

bull Hypoglicemia

bull Subcutaneus adipous tissue

ndash Complications are increasing

bull There is no critical

treshold

ndash Biological condition

ndash Definition of GDM is

difficult

ACHOISEffect of treatment of gestational diabetes mellitus on pregnancy outcomesCrowther CA N Engl J Med 2005 Jun 16352(24)2477-86 Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group

Screenig 75 g (Cases with a fasting 105-WHO criteria interval are included)

Controversies in Gestational Diabetes

bull Screen or not

bull Selective or universal screening

bull One or two step testing

bull Criteria for diagnosis

bull Criteria for the use of insulin

bull Role of oral hypoglycaemic drugs

Diabetes in Pregnancy

bull Prevalence 3-14

bull Predisposition to Type 2

DM

ndash 50 gt type 2 DM

bull Recurrence in future

pregnancies 30-84

Gestational diabetes

Diabetes diagnosed first time

in pregnancy

bull15-20 pregestational

bullMore complications

bullScreening at first visit (B) Albrecht SS 2010

Diabetes in Pregnancy

Epidemiology

Albrecht SS 2010

Diabetes in Pregnancy 6-7

of GDM 90

O Total

GDM

Type 2

Type 1

Hyperglicemia

Shoulder dystocia

LGA

Why Diagnose and Treat GDM

Mother Fetus Newborn Childhood

Addult

Dystosia Macrosomia RDS Obesity

CS Shoulder dystocia

and nerve injury

Hypoglicemia Type II diabetes

Preeclampsia Cardiomyopathy Hypocalcemia Metabolic

syndrome

Type II diabetes Preterm delivery Hyperbilirubinemia

Metabolic

syndrome

Policytemia

What happened in recent years with

gestational diabetes

bull Studies showed thatndash mild hyperglicemia have adverse effects on pregnancy results

ndash and treatment is beneficial

bull One step screening with 75 gr OGTT is recommended(IADPSG)

bull Oral antidiabetics are in use

Studies

bull HAPO Hyperglycemia and adverse pregnancy outcomesndash HAPO Study N Engl J Med 20083581991

bull ACHOIS Effect of treatment of gestational diabetes mellitus on pregnancy outcomesndash Crowther CA et al N Engl J Med 20053522477

bull MFMUN A Multicenter Randomized Trial of Treatment for Mild Gestational Diabetesndash Landon MB et al N Engl J Med 20093611339

HAPO

ndash NEJM 2008

ndash Prospective blinded

ndash Multicenter different etnic groups

bull 25505 women

bull 24 ndash 32 w 75 gr GTT

ndash Exclusion

Fasting gt105 mgdL or

2 h ge200 mgdL or

Random ge160 mgdL

bull Aim

ndash To investigate maternal mild

hyperglicemia related

pregnancy risks

bull Fasting glucose levels divided 7 groups (5 mgdl intervals)

HAPO Incidence of Adverse Outcomes

Increases Along Continuum

Metzger BE et al Hyperglycemia and Adverse Pregnancy Outcomes NEJM 2008358(19)1991-2002

HAPO-Result

bull With increasing glocose

levelsndash Birth weight

ndash Cord C-Peptid levels

ndash CS

ndash Neonatal

bull Hypoglicemia

bull Subcutaneus adipous tissue

ndash Complications are increasing

bull There is no critical

treshold

ndash Biological condition

ndash Definition of GDM is

difficult

ACHOISEffect of treatment of gestational diabetes mellitus on pregnancy outcomesCrowther CA N Engl J Med 2005 Jun 16352(24)2477-86 Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group

Screenig 75 g (Cases with a fasting 105-WHO criteria interval are included)

Diabetes in Pregnancy

bull Prevalence 3-14

bull Predisposition to Type 2

DM

ndash 50 gt type 2 DM

bull Recurrence in future

pregnancies 30-84

Gestational diabetes

Diabetes diagnosed first time

in pregnancy

bull15-20 pregestational

bullMore complications

bullScreening at first visit (B) Albrecht SS 2010

Diabetes in Pregnancy

Epidemiology

Albrecht SS 2010

Diabetes in Pregnancy 6-7

of GDM 90

O Total

GDM

Type 2

Type 1

Hyperglicemia

Shoulder dystocia

LGA

Why Diagnose and Treat GDM

Mother Fetus Newborn Childhood

Addult

Dystosia Macrosomia RDS Obesity

CS Shoulder dystocia

and nerve injury

Hypoglicemia Type II diabetes

Preeclampsia Cardiomyopathy Hypocalcemia Metabolic

syndrome

Type II diabetes Preterm delivery Hyperbilirubinemia

Metabolic

syndrome

Policytemia

What happened in recent years with

gestational diabetes

bull Studies showed thatndash mild hyperglicemia have adverse effects on pregnancy results

ndash and treatment is beneficial

bull One step screening with 75 gr OGTT is recommended(IADPSG)

bull Oral antidiabetics are in use

Studies

bull HAPO Hyperglycemia and adverse pregnancy outcomesndash HAPO Study N Engl J Med 20083581991

bull ACHOIS Effect of treatment of gestational diabetes mellitus on pregnancy outcomesndash Crowther CA et al N Engl J Med 20053522477

bull MFMUN A Multicenter Randomized Trial of Treatment for Mild Gestational Diabetesndash Landon MB et al N Engl J Med 20093611339

HAPO

ndash NEJM 2008

ndash Prospective blinded

ndash Multicenter different etnic groups

bull 25505 women

bull 24 ndash 32 w 75 gr GTT

ndash Exclusion

Fasting gt105 mgdL or

2 h ge200 mgdL or

Random ge160 mgdL

bull Aim

ndash To investigate maternal mild

hyperglicemia related

pregnancy risks

bull Fasting glucose levels divided 7 groups (5 mgdl intervals)

HAPO Incidence of Adverse Outcomes

Increases Along Continuum

Metzger BE et al Hyperglycemia and Adverse Pregnancy Outcomes NEJM 2008358(19)1991-2002

HAPO-Result

bull With increasing glocose

levelsndash Birth weight

ndash Cord C-Peptid levels

ndash CS

ndash Neonatal

bull Hypoglicemia

bull Subcutaneus adipous tissue

ndash Complications are increasing

bull There is no critical

treshold

ndash Biological condition

ndash Definition of GDM is

difficult

ACHOISEffect of treatment of gestational diabetes mellitus on pregnancy outcomesCrowther CA N Engl J Med 2005 Jun 16352(24)2477-86 Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group

Screenig 75 g (Cases with a fasting 105-WHO criteria interval are included)

Diabetes in Pregnancy

Epidemiology

Albrecht SS 2010

Diabetes in Pregnancy 6-7

of GDM 90

O Total

GDM

Type 2

Type 1

Hyperglicemia

Shoulder dystocia

LGA

Why Diagnose and Treat GDM

Mother Fetus Newborn Childhood

Addult

Dystosia Macrosomia RDS Obesity

CS Shoulder dystocia

and nerve injury

Hypoglicemia Type II diabetes

Preeclampsia Cardiomyopathy Hypocalcemia Metabolic

syndrome

Type II diabetes Preterm delivery Hyperbilirubinemia

Metabolic

syndrome

Policytemia

What happened in recent years with

gestational diabetes

bull Studies showed thatndash mild hyperglicemia have adverse effects on pregnancy results

ndash and treatment is beneficial

bull One step screening with 75 gr OGTT is recommended(IADPSG)

bull Oral antidiabetics are in use

Studies

bull HAPO Hyperglycemia and adverse pregnancy outcomesndash HAPO Study N Engl J Med 20083581991

bull ACHOIS Effect of treatment of gestational diabetes mellitus on pregnancy outcomesndash Crowther CA et al N Engl J Med 20053522477

bull MFMUN A Multicenter Randomized Trial of Treatment for Mild Gestational Diabetesndash Landon MB et al N Engl J Med 20093611339

HAPO

ndash NEJM 2008

ndash Prospective blinded

ndash Multicenter different etnic groups

bull 25505 women

bull 24 ndash 32 w 75 gr GTT

ndash Exclusion

Fasting gt105 mgdL or

2 h ge200 mgdL or

Random ge160 mgdL

bull Aim

ndash To investigate maternal mild

hyperglicemia related

pregnancy risks

bull Fasting glucose levels divided 7 groups (5 mgdl intervals)

HAPO Incidence of Adverse Outcomes

Increases Along Continuum

Metzger BE et al Hyperglycemia and Adverse Pregnancy Outcomes NEJM 2008358(19)1991-2002

HAPO-Result

bull With increasing glocose

levelsndash Birth weight

ndash Cord C-Peptid levels

ndash CS

ndash Neonatal

bull Hypoglicemia

bull Subcutaneus adipous tissue

ndash Complications are increasing

bull There is no critical

treshold

ndash Biological condition

ndash Definition of GDM is

difficult

ACHOISEffect of treatment of gestational diabetes mellitus on pregnancy outcomesCrowther CA N Engl J Med 2005 Jun 16352(24)2477-86 Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group

Screenig 75 g (Cases with a fasting 105-WHO criteria interval are included)

Hyperglicemia

Shoulder dystocia

LGA

Why Diagnose and Treat GDM

Mother Fetus Newborn Childhood

Addult

Dystosia Macrosomia RDS Obesity

CS Shoulder dystocia

and nerve injury

Hypoglicemia Type II diabetes

Preeclampsia Cardiomyopathy Hypocalcemia Metabolic

syndrome

Type II diabetes Preterm delivery Hyperbilirubinemia

Metabolic

syndrome

Policytemia

What happened in recent years with

gestational diabetes

bull Studies showed thatndash mild hyperglicemia have adverse effects on pregnancy results

ndash and treatment is beneficial

bull One step screening with 75 gr OGTT is recommended(IADPSG)

bull Oral antidiabetics are in use

Studies

bull HAPO Hyperglycemia and adverse pregnancy outcomesndash HAPO Study N Engl J Med 20083581991

bull ACHOIS Effect of treatment of gestational diabetes mellitus on pregnancy outcomesndash Crowther CA et al N Engl J Med 20053522477

bull MFMUN A Multicenter Randomized Trial of Treatment for Mild Gestational Diabetesndash Landon MB et al N Engl J Med 20093611339

HAPO

ndash NEJM 2008

ndash Prospective blinded

ndash Multicenter different etnic groups

bull 25505 women

bull 24 ndash 32 w 75 gr GTT

ndash Exclusion

Fasting gt105 mgdL or

2 h ge200 mgdL or

Random ge160 mgdL

bull Aim

ndash To investigate maternal mild

hyperglicemia related

pregnancy risks

bull Fasting glucose levels divided 7 groups (5 mgdl intervals)

HAPO Incidence of Adverse Outcomes

Increases Along Continuum

Metzger BE et al Hyperglycemia and Adverse Pregnancy Outcomes NEJM 2008358(19)1991-2002

HAPO-Result

bull With increasing glocose

levelsndash Birth weight

ndash Cord C-Peptid levels

ndash CS

ndash Neonatal

bull Hypoglicemia

bull Subcutaneus adipous tissue

ndash Complications are increasing

bull There is no critical

treshold

ndash Biological condition

ndash Definition of GDM is

difficult

ACHOISEffect of treatment of gestational diabetes mellitus on pregnancy outcomesCrowther CA N Engl J Med 2005 Jun 16352(24)2477-86 Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group

Screenig 75 g (Cases with a fasting 105-WHO criteria interval are included)

Why Diagnose and Treat GDM

Mother Fetus Newborn Childhood

Addult

Dystosia Macrosomia RDS Obesity

CS Shoulder dystocia

and nerve injury

Hypoglicemia Type II diabetes

Preeclampsia Cardiomyopathy Hypocalcemia Metabolic

syndrome

Type II diabetes Preterm delivery Hyperbilirubinemia

Metabolic

syndrome

Policytemia

What happened in recent years with

gestational diabetes

bull Studies showed thatndash mild hyperglicemia have adverse effects on pregnancy results

ndash and treatment is beneficial

bull One step screening with 75 gr OGTT is recommended(IADPSG)

bull Oral antidiabetics are in use

Studies

bull HAPO Hyperglycemia and adverse pregnancy outcomesndash HAPO Study N Engl J Med 20083581991

bull ACHOIS Effect of treatment of gestational diabetes mellitus on pregnancy outcomesndash Crowther CA et al N Engl J Med 20053522477

bull MFMUN A Multicenter Randomized Trial of Treatment for Mild Gestational Diabetesndash Landon MB et al N Engl J Med 20093611339

HAPO

ndash NEJM 2008

ndash Prospective blinded

ndash Multicenter different etnic groups

bull 25505 women

bull 24 ndash 32 w 75 gr GTT

ndash Exclusion

Fasting gt105 mgdL or

2 h ge200 mgdL or

Random ge160 mgdL

bull Aim

ndash To investigate maternal mild

hyperglicemia related

pregnancy risks

bull Fasting glucose levels divided 7 groups (5 mgdl intervals)

HAPO Incidence of Adverse Outcomes

Increases Along Continuum

Metzger BE et al Hyperglycemia and Adverse Pregnancy Outcomes NEJM 2008358(19)1991-2002

HAPO-Result

bull With increasing glocose

levelsndash Birth weight

ndash Cord C-Peptid levels

ndash CS

ndash Neonatal

bull Hypoglicemia

bull Subcutaneus adipous tissue

ndash Complications are increasing

bull There is no critical

treshold

ndash Biological condition

ndash Definition of GDM is

difficult

ACHOISEffect of treatment of gestational diabetes mellitus on pregnancy outcomesCrowther CA N Engl J Med 2005 Jun 16352(24)2477-86 Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group

Screenig 75 g (Cases with a fasting 105-WHO criteria interval are included)

What happened in recent years with

gestational diabetes

bull Studies showed thatndash mild hyperglicemia have adverse effects on pregnancy results

ndash and treatment is beneficial

bull One step screening with 75 gr OGTT is recommended(IADPSG)

bull Oral antidiabetics are in use

Studies

bull HAPO Hyperglycemia and adverse pregnancy outcomesndash HAPO Study N Engl J Med 20083581991

bull ACHOIS Effect of treatment of gestational diabetes mellitus on pregnancy outcomesndash Crowther CA et al N Engl J Med 20053522477

bull MFMUN A Multicenter Randomized Trial of Treatment for Mild Gestational Diabetesndash Landon MB et al N Engl J Med 20093611339

HAPO

ndash NEJM 2008

ndash Prospective blinded

ndash Multicenter different etnic groups

bull 25505 women

bull 24 ndash 32 w 75 gr GTT

ndash Exclusion

Fasting gt105 mgdL or

2 h ge200 mgdL or

Random ge160 mgdL

bull Aim

ndash To investigate maternal mild

hyperglicemia related

pregnancy risks

bull Fasting glucose levels divided 7 groups (5 mgdl intervals)

HAPO Incidence of Adverse Outcomes

Increases Along Continuum

Metzger BE et al Hyperglycemia and Adverse Pregnancy Outcomes NEJM 2008358(19)1991-2002

HAPO-Result

bull With increasing glocose

levelsndash Birth weight

ndash Cord C-Peptid levels

ndash CS

ndash Neonatal

bull Hypoglicemia

bull Subcutaneus adipous tissue

ndash Complications are increasing

bull There is no critical

treshold

ndash Biological condition

ndash Definition of GDM is

difficult

ACHOISEffect of treatment of gestational diabetes mellitus on pregnancy outcomesCrowther CA N Engl J Med 2005 Jun 16352(24)2477-86 Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group

Screenig 75 g (Cases with a fasting 105-WHO criteria interval are included)

Studies

bull HAPO Hyperglycemia and adverse pregnancy outcomesndash HAPO Study N Engl J Med 20083581991

bull ACHOIS Effect of treatment of gestational diabetes mellitus on pregnancy outcomesndash Crowther CA et al N Engl J Med 20053522477

bull MFMUN A Multicenter Randomized Trial of Treatment for Mild Gestational Diabetesndash Landon MB et al N Engl J Med 20093611339

HAPO

ndash NEJM 2008

ndash Prospective blinded

ndash Multicenter different etnic groups

bull 25505 women

bull 24 ndash 32 w 75 gr GTT

ndash Exclusion

Fasting gt105 mgdL or

2 h ge200 mgdL or

Random ge160 mgdL

bull Aim

ndash To investigate maternal mild

hyperglicemia related

pregnancy risks

bull Fasting glucose levels divided 7 groups (5 mgdl intervals)

HAPO Incidence of Adverse Outcomes

Increases Along Continuum

Metzger BE et al Hyperglycemia and Adverse Pregnancy Outcomes NEJM 2008358(19)1991-2002

HAPO-Result

bull With increasing glocose

levelsndash Birth weight

ndash Cord C-Peptid levels

ndash CS

ndash Neonatal

bull Hypoglicemia

bull Subcutaneus adipous tissue

ndash Complications are increasing

bull There is no critical

treshold

ndash Biological condition

ndash Definition of GDM is

difficult

ACHOISEffect of treatment of gestational diabetes mellitus on pregnancy outcomesCrowther CA N Engl J Med 2005 Jun 16352(24)2477-86 Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group

Screenig 75 g (Cases with a fasting 105-WHO criteria interval are included)

HAPO

ndash NEJM 2008

ndash Prospective blinded

ndash Multicenter different etnic groups

bull 25505 women

bull 24 ndash 32 w 75 gr GTT

ndash Exclusion

Fasting gt105 mgdL or

2 h ge200 mgdL or

Random ge160 mgdL

bull Aim

ndash To investigate maternal mild

hyperglicemia related

pregnancy risks

bull Fasting glucose levels divided 7 groups (5 mgdl intervals)

HAPO Incidence of Adverse Outcomes

Increases Along Continuum

Metzger BE et al Hyperglycemia and Adverse Pregnancy Outcomes NEJM 2008358(19)1991-2002

HAPO-Result

bull With increasing glocose

levelsndash Birth weight

ndash Cord C-Peptid levels

ndash CS

ndash Neonatal

bull Hypoglicemia

bull Subcutaneus adipous tissue

ndash Complications are increasing

bull There is no critical

treshold

ndash Biological condition

ndash Definition of GDM is

difficult

ACHOISEffect of treatment of gestational diabetes mellitus on pregnancy outcomesCrowther CA N Engl J Med 2005 Jun 16352(24)2477-86 Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group

Screenig 75 g (Cases with a fasting 105-WHO criteria interval are included)

HAPO Incidence of Adverse Outcomes

Increases Along Continuum

Metzger BE et al Hyperglycemia and Adverse Pregnancy Outcomes NEJM 2008358(19)1991-2002

HAPO-Result

bull With increasing glocose

levelsndash Birth weight

ndash Cord C-Peptid levels

ndash CS

ndash Neonatal

bull Hypoglicemia

bull Subcutaneus adipous tissue

ndash Complications are increasing

bull There is no critical

treshold

ndash Biological condition

ndash Definition of GDM is

difficult

ACHOISEffect of treatment of gestational diabetes mellitus on pregnancy outcomesCrowther CA N Engl J Med 2005 Jun 16352(24)2477-86 Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group

Screenig 75 g (Cases with a fasting 105-WHO criteria interval are included)

HAPO-Result

bull With increasing glocose

levelsndash Birth weight

ndash Cord C-Peptid levels

ndash CS

ndash Neonatal

bull Hypoglicemia

bull Subcutaneus adipous tissue

ndash Complications are increasing

bull There is no critical

treshold

ndash Biological condition

ndash Definition of GDM is

difficult

ACHOISEffect of treatment of gestational diabetes mellitus on pregnancy outcomesCrowther CA N Engl J Med 2005 Jun 16352(24)2477-86 Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group

Screenig 75 g (Cases with a fasting 105-WHO criteria interval are included)

ACHOISEffect of treatment of gestational diabetes mellitus on pregnancy outcomesCrowther CA N Engl J Med 2005 Jun 16352(24)2477-86 Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group

Screenig 75 g (Cases with a fasting 105-WHO criteria interval are included)

MFMUN-GDM

bull 24-31 wndash 50 g+100 g OGTT

ndash Fastinglt95 mg

bull Randomizationndash 485 case (Diet + insulin if needed)

ndash 473 control

bull Primary resultsndash fetal or perinatal death

ndash birth trauma

ndash neonatal complications

bull Results

bull Composit resultsndash 324 vs 370 (p 014)ndash No perinatal death

bull Birth weightndash 3302 vs 3408 g (p 0001)

bull LGA ndash 71 vs 145 (p 0001)

bull Shoulder dystociandash 15 vs 40 (p 002)

bull CSndash 269 vs 338 (p 002)

bull PIHndash 86 vs 136 (p 001)

A Multicenter Randomized Trial of Treatment for Mild Gestational Diabetes Mark B Landon N Engl J Med 2009 October 1 361(14) 1339ndash1348 Eunice Kennedy Shriver National Institute

GDM Screening

bull Universal

ndash Endocrine Society 2013

ndash ACOG 2011

ndash ADA 2011

ndash SOGC 2002

ndash AACE 2007

ndash WHO 1999

bull Risk based

ndash NICE 2008

ndash US Preventive Task Force 2008

bull (2013) now recommends

universal screening

GDM Screening Based on Risk Assessment

Risk category Recommendation

High riskObesity Strong family history of type 2 diabetes Previous history of GDMImpaired glucose metabolism or glucosuria Ethnic group with a low prevalence of GDMAge ge35 yearsPolycystic ovarian syndromeAcanthosis nigricans

Testing as soon as feasable and

Testing at 24 to 28 weeks

Moderate risk Testing at 24 to 28 weeks

Low riskEthnic group with a low prevalence of GDM No known diabetes in first-degree relatives Age lt 25 years Weight normal before pregnancy Weight normal at birth No history of abnormal glucose metabolism No history of poor obstetrical outcome

Testing not routinely required

NICE

US Preventive Services Task

Force

Standarts of Medical Care in Diabetes Diabetes Care 2012

GDM ScreeningAll Women

bull First visit bull 24-28 w

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

US Preventive Task Force 2013

First visitFasting HbA1c Random PG

Fasting ge126 mgdL

HbA1c ge65

Random PG ge200 mgdL

Overt Diabetes

Fasting ge92lt126 mgdL

GDM

Fasting lt92 mgdL

HbA1c lt65

PG lt200 mgdL

24 ndash 28 w

screening

IADPSG 2010

ADA 2012

ES 2013

Screening24-28 weeks

bull Two Step

ndash 50g

ndash 100g or 75g OGTT

bull One step

ndash 100 or 75g OGTT

Two step

1H PG 140 135 130

Sensitivity 79 98 100

Specificity 87 80 78

Positive test 13 20 22

50 g

Plasma glucose (mgdl)

National Diabetes

Data Group (1979)1

The Fourth International Workshop-

Conference on Gestational Diabetes2

Fasting 105 95

1h 190 180

2h 165 155

3h 145 140

100 g OGTT

1 National Diabetes Group 1979

2 Fourth International Workshop-Conference on Gestational Diabetes Mellitus Diabetes Care 1998

GDM 3-8

2 ge values

One Step-75 g OGTT

Abnorm

Result

Plasma glucose level (mgdl) Prevalance()

CDA gt2 F 95 1 h 190 2h 160 79

EASD gt1 F 108 2 h 162 97

ADA gt2 F 95 1 h 180 2 h 155 106

NZSSD gt1 F 99 2 h 162 176

WHO gt1 F 126 2 h 140 196

ADIPS gt1 F 99 2 h 144 249

ADA American Diabetes Association ADIPS Australasian Diabetes in Pregnancy Society CDA

Canadian Diabetes Association EASD European Association for the Study of Diabetes NZSSD

New Zealand Society for the Study of Diabetes WHO World Health Organization

Diabetes Care 201022676-682

IADPSG

June 2008 Pasadena California

225 conferees from 40 countries reviewed (HAPO) study

HAPO Incidence of Adverse Outcomes for

Glucose Categories (OR 175 or 20 )

Metzger BE et al HAPO NEJM 2008358(19)1991-2002

IADPSG Kriterleri

Coustan DR Paving the way for new diagnostic criteria for GDM 2010

HAPO

One step

Plasma Glucose

Fasting 92 mgdl

1 h 180 mgdl

2 h 153 mgdl

75 G OGTT

GDM 161

Single value

IADPSG 2010

ADA 2012

ES 2013

Obesity and diabetes in USA

South East Asia amp Pacific RegionNauru 78Tonga 70Samoa 63Niue 46French Polynesia 44

AfricaSeychelles 28South Africa 28Ghana 20 Mauritania 19Cameroon (urban) 14

South Central AmericaPanama 36Paraguay 36Peru (urban) 23Chile (urban) 23Dominican Republic 18

North AmericaUSA 33Barbados 31Mexico 29St Lucia 28Bahamas 28

Eastern MediterraneanJordan 60Qatar 45Saudi Arabia 44Israel 43Lebanon 38

European RegionAlbania 36Malta 35Turkey 29Slovakia 28Czech Republic 26

Obese

0-99

10-149

15-199

20-249

25-299

ge30

Obesityndash Global prevalance

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

GDM Screening Based on Risk Assessment

Risk category Recommendation

High riskObesity Strong family history of type 2 diabetes Previous history of GDMImpaired glucose metabolism or glucosuria Ethnic group with a low prevalence of GDMAge ge35 yearsPolycystic ovarian syndromeAcanthosis nigricans

Testing as soon as feasable and

Testing at 24 to 28 weeks

Moderate risk Testing at 24 to 28 weeks

Low riskEthnic group with a low prevalence of GDM No known diabetes in first-degree relatives Age lt 25 years Weight normal before pregnancy Weight normal at birth No history of abnormal glucose metabolism No history of poor obstetrical outcome

Testing not routinely required

NICE

US Preventive Services Task

Force

Standarts of Medical Care in Diabetes Diabetes Care 2012

GDM ScreeningAll Women

bull First visit bull 24-28 w

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

US Preventive Task Force 2013

First visitFasting HbA1c Random PG

Fasting ge126 mgdL

HbA1c ge65

Random PG ge200 mgdL

Overt Diabetes

Fasting ge92lt126 mgdL

GDM

Fasting lt92 mgdL

HbA1c lt65

PG lt200 mgdL

24 ndash 28 w

screening

IADPSG 2010

ADA 2012

ES 2013

Screening24-28 weeks

bull Two Step

ndash 50g

ndash 100g or 75g OGTT

bull One step

ndash 100 or 75g OGTT

Two step

1H PG 140 135 130

Sensitivity 79 98 100

Specificity 87 80 78

Positive test 13 20 22

50 g

Plasma glucose (mgdl)

National Diabetes

Data Group (1979)1

The Fourth International Workshop-

Conference on Gestational Diabetes2

Fasting 105 95

1h 190 180

2h 165 155

3h 145 140

100 g OGTT

1 National Diabetes Group 1979

2 Fourth International Workshop-Conference on Gestational Diabetes Mellitus Diabetes Care 1998

GDM 3-8

2 ge values

One Step-75 g OGTT

Abnorm

Result

Plasma glucose level (mgdl) Prevalance()

CDA gt2 F 95 1 h 190 2h 160 79

EASD gt1 F 108 2 h 162 97

ADA gt2 F 95 1 h 180 2 h 155 106

NZSSD gt1 F 99 2 h 162 176

WHO gt1 F 126 2 h 140 196

ADIPS gt1 F 99 2 h 144 249

ADA American Diabetes Association ADIPS Australasian Diabetes in Pregnancy Society CDA

Canadian Diabetes Association EASD European Association for the Study of Diabetes NZSSD

New Zealand Society for the Study of Diabetes WHO World Health Organization

Diabetes Care 201022676-682

IADPSG

June 2008 Pasadena California

225 conferees from 40 countries reviewed (HAPO) study

HAPO Incidence of Adverse Outcomes for

Glucose Categories (OR 175 or 20 )

Metzger BE et al HAPO NEJM 2008358(19)1991-2002

IADPSG Kriterleri

Coustan DR Paving the way for new diagnostic criteria for GDM 2010

HAPO

One step

Plasma Glucose

Fasting 92 mgdl

1 h 180 mgdl

2 h 153 mgdl

75 G OGTT

GDM 161

Single value

IADPSG 2010

ADA 2012

ES 2013

Obesity and diabetes in USA

South East Asia amp Pacific RegionNauru 78Tonga 70Samoa 63Niue 46French Polynesia 44

AfricaSeychelles 28South Africa 28Ghana 20 Mauritania 19Cameroon (urban) 14

South Central AmericaPanama 36Paraguay 36Peru (urban) 23Chile (urban) 23Dominican Republic 18

North AmericaUSA 33Barbados 31Mexico 29St Lucia 28Bahamas 28

Eastern MediterraneanJordan 60Qatar 45Saudi Arabia 44Israel 43Lebanon 38

European RegionAlbania 36Malta 35Turkey 29Slovakia 28Czech Republic 26

Obese

0-99

10-149

15-199

20-249

25-299

ge30

Obesityndash Global prevalance

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

GDM ScreeningAll Women

bull First visit bull 24-28 w

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

US Preventive Task Force 2013

First visitFasting HbA1c Random PG

Fasting ge126 mgdL

HbA1c ge65

Random PG ge200 mgdL

Overt Diabetes

Fasting ge92lt126 mgdL

GDM

Fasting lt92 mgdL

HbA1c lt65

PG lt200 mgdL

24 ndash 28 w

screening

IADPSG 2010

ADA 2012

ES 2013

Screening24-28 weeks

bull Two Step

ndash 50g

ndash 100g or 75g OGTT

bull One step

ndash 100 or 75g OGTT

Two step

1H PG 140 135 130

Sensitivity 79 98 100

Specificity 87 80 78

Positive test 13 20 22

50 g

Plasma glucose (mgdl)

National Diabetes

Data Group (1979)1

The Fourth International Workshop-

Conference on Gestational Diabetes2

Fasting 105 95

1h 190 180

2h 165 155

3h 145 140

100 g OGTT

1 National Diabetes Group 1979

2 Fourth International Workshop-Conference on Gestational Diabetes Mellitus Diabetes Care 1998

GDM 3-8

2 ge values

One Step-75 g OGTT

Abnorm

Result

Plasma glucose level (mgdl) Prevalance()

CDA gt2 F 95 1 h 190 2h 160 79

EASD gt1 F 108 2 h 162 97

ADA gt2 F 95 1 h 180 2 h 155 106

NZSSD gt1 F 99 2 h 162 176

WHO gt1 F 126 2 h 140 196

ADIPS gt1 F 99 2 h 144 249

ADA American Diabetes Association ADIPS Australasian Diabetes in Pregnancy Society CDA

Canadian Diabetes Association EASD European Association for the Study of Diabetes NZSSD

New Zealand Society for the Study of Diabetes WHO World Health Organization

Diabetes Care 201022676-682

IADPSG

June 2008 Pasadena California

225 conferees from 40 countries reviewed (HAPO) study

HAPO Incidence of Adverse Outcomes for

Glucose Categories (OR 175 or 20 )

Metzger BE et al HAPO NEJM 2008358(19)1991-2002

IADPSG Kriterleri

Coustan DR Paving the way for new diagnostic criteria for GDM 2010

HAPO

One step

Plasma Glucose

Fasting 92 mgdl

1 h 180 mgdl

2 h 153 mgdl

75 G OGTT

GDM 161

Single value

IADPSG 2010

ADA 2012

ES 2013

Obesity and diabetes in USA

South East Asia amp Pacific RegionNauru 78Tonga 70Samoa 63Niue 46French Polynesia 44

AfricaSeychelles 28South Africa 28Ghana 20 Mauritania 19Cameroon (urban) 14

South Central AmericaPanama 36Paraguay 36Peru (urban) 23Chile (urban) 23Dominican Republic 18

North AmericaUSA 33Barbados 31Mexico 29St Lucia 28Bahamas 28

Eastern MediterraneanJordan 60Qatar 45Saudi Arabia 44Israel 43Lebanon 38

European RegionAlbania 36Malta 35Turkey 29Slovakia 28Czech Republic 26

Obese

0-99

10-149

15-199

20-249

25-299

ge30

Obesityndash Global prevalance

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

First visitFasting HbA1c Random PG

Fasting ge126 mgdL

HbA1c ge65

Random PG ge200 mgdL

Overt Diabetes

Fasting ge92lt126 mgdL

GDM

Fasting lt92 mgdL

HbA1c lt65

PG lt200 mgdL

24 ndash 28 w

screening

IADPSG 2010

ADA 2012

ES 2013

Screening24-28 weeks

bull Two Step

ndash 50g

ndash 100g or 75g OGTT

bull One step

ndash 100 or 75g OGTT

Two step

1H PG 140 135 130

Sensitivity 79 98 100

Specificity 87 80 78

Positive test 13 20 22

50 g

Plasma glucose (mgdl)

National Diabetes

Data Group (1979)1

The Fourth International Workshop-

Conference on Gestational Diabetes2

Fasting 105 95

1h 190 180

2h 165 155

3h 145 140

100 g OGTT

1 National Diabetes Group 1979

2 Fourth International Workshop-Conference on Gestational Diabetes Mellitus Diabetes Care 1998

GDM 3-8

2 ge values

One Step-75 g OGTT

Abnorm

Result

Plasma glucose level (mgdl) Prevalance()

CDA gt2 F 95 1 h 190 2h 160 79

EASD gt1 F 108 2 h 162 97

ADA gt2 F 95 1 h 180 2 h 155 106

NZSSD gt1 F 99 2 h 162 176

WHO gt1 F 126 2 h 140 196

ADIPS gt1 F 99 2 h 144 249

ADA American Diabetes Association ADIPS Australasian Diabetes in Pregnancy Society CDA

Canadian Diabetes Association EASD European Association for the Study of Diabetes NZSSD

New Zealand Society for the Study of Diabetes WHO World Health Organization

Diabetes Care 201022676-682

IADPSG

June 2008 Pasadena California

225 conferees from 40 countries reviewed (HAPO) study

HAPO Incidence of Adverse Outcomes for

Glucose Categories (OR 175 or 20 )

Metzger BE et al HAPO NEJM 2008358(19)1991-2002

IADPSG Kriterleri

Coustan DR Paving the way for new diagnostic criteria for GDM 2010

HAPO

One step

Plasma Glucose

Fasting 92 mgdl

1 h 180 mgdl

2 h 153 mgdl

75 G OGTT

GDM 161

Single value

IADPSG 2010

ADA 2012

ES 2013

Obesity and diabetes in USA

South East Asia amp Pacific RegionNauru 78Tonga 70Samoa 63Niue 46French Polynesia 44

AfricaSeychelles 28South Africa 28Ghana 20 Mauritania 19Cameroon (urban) 14

South Central AmericaPanama 36Paraguay 36Peru (urban) 23Chile (urban) 23Dominican Republic 18

North AmericaUSA 33Barbados 31Mexico 29St Lucia 28Bahamas 28

Eastern MediterraneanJordan 60Qatar 45Saudi Arabia 44Israel 43Lebanon 38

European RegionAlbania 36Malta 35Turkey 29Slovakia 28Czech Republic 26

Obese

0-99

10-149

15-199

20-249

25-299

ge30

Obesityndash Global prevalance

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

Screening24-28 weeks

bull Two Step

ndash 50g

ndash 100g or 75g OGTT

bull One step

ndash 100 or 75g OGTT

Two step

1H PG 140 135 130

Sensitivity 79 98 100

Specificity 87 80 78

Positive test 13 20 22

50 g

Plasma glucose (mgdl)

National Diabetes

Data Group (1979)1

The Fourth International Workshop-

Conference on Gestational Diabetes2

Fasting 105 95

1h 190 180

2h 165 155

3h 145 140

100 g OGTT

1 National Diabetes Group 1979

2 Fourth International Workshop-Conference on Gestational Diabetes Mellitus Diabetes Care 1998

GDM 3-8

2 ge values

One Step-75 g OGTT

Abnorm

Result

Plasma glucose level (mgdl) Prevalance()

CDA gt2 F 95 1 h 190 2h 160 79

EASD gt1 F 108 2 h 162 97

ADA gt2 F 95 1 h 180 2 h 155 106

NZSSD gt1 F 99 2 h 162 176

WHO gt1 F 126 2 h 140 196

ADIPS gt1 F 99 2 h 144 249

ADA American Diabetes Association ADIPS Australasian Diabetes in Pregnancy Society CDA

Canadian Diabetes Association EASD European Association for the Study of Diabetes NZSSD

New Zealand Society for the Study of Diabetes WHO World Health Organization

Diabetes Care 201022676-682

IADPSG

June 2008 Pasadena California

225 conferees from 40 countries reviewed (HAPO) study

HAPO Incidence of Adverse Outcomes for

Glucose Categories (OR 175 or 20 )

Metzger BE et al HAPO NEJM 2008358(19)1991-2002

IADPSG Kriterleri

Coustan DR Paving the way for new diagnostic criteria for GDM 2010

HAPO

One step

Plasma Glucose

Fasting 92 mgdl

1 h 180 mgdl

2 h 153 mgdl

75 G OGTT

GDM 161

Single value

IADPSG 2010

ADA 2012

ES 2013

Obesity and diabetes in USA

South East Asia amp Pacific RegionNauru 78Tonga 70Samoa 63Niue 46French Polynesia 44

AfricaSeychelles 28South Africa 28Ghana 20 Mauritania 19Cameroon (urban) 14

South Central AmericaPanama 36Paraguay 36Peru (urban) 23Chile (urban) 23Dominican Republic 18

North AmericaUSA 33Barbados 31Mexico 29St Lucia 28Bahamas 28

Eastern MediterraneanJordan 60Qatar 45Saudi Arabia 44Israel 43Lebanon 38

European RegionAlbania 36Malta 35Turkey 29Slovakia 28Czech Republic 26

Obese

0-99

10-149

15-199

20-249

25-299

ge30

Obesityndash Global prevalance

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

Two step

1H PG 140 135 130

Sensitivity 79 98 100

Specificity 87 80 78

Positive test 13 20 22

50 g

Plasma glucose (mgdl)

National Diabetes

Data Group (1979)1

The Fourth International Workshop-

Conference on Gestational Diabetes2

Fasting 105 95

1h 190 180

2h 165 155

3h 145 140

100 g OGTT

1 National Diabetes Group 1979

2 Fourth International Workshop-Conference on Gestational Diabetes Mellitus Diabetes Care 1998

GDM 3-8

2 ge values

One Step-75 g OGTT

Abnorm

Result

Plasma glucose level (mgdl) Prevalance()

CDA gt2 F 95 1 h 190 2h 160 79

EASD gt1 F 108 2 h 162 97

ADA gt2 F 95 1 h 180 2 h 155 106

NZSSD gt1 F 99 2 h 162 176

WHO gt1 F 126 2 h 140 196

ADIPS gt1 F 99 2 h 144 249

ADA American Diabetes Association ADIPS Australasian Diabetes in Pregnancy Society CDA

Canadian Diabetes Association EASD European Association for the Study of Diabetes NZSSD

New Zealand Society for the Study of Diabetes WHO World Health Organization

Diabetes Care 201022676-682

IADPSG

June 2008 Pasadena California

225 conferees from 40 countries reviewed (HAPO) study

HAPO Incidence of Adverse Outcomes for

Glucose Categories (OR 175 or 20 )

Metzger BE et al HAPO NEJM 2008358(19)1991-2002

IADPSG Kriterleri

Coustan DR Paving the way for new diagnostic criteria for GDM 2010

HAPO

One step

Plasma Glucose

Fasting 92 mgdl

1 h 180 mgdl

2 h 153 mgdl

75 G OGTT

GDM 161

Single value

IADPSG 2010

ADA 2012

ES 2013

Obesity and diabetes in USA

South East Asia amp Pacific RegionNauru 78Tonga 70Samoa 63Niue 46French Polynesia 44

AfricaSeychelles 28South Africa 28Ghana 20 Mauritania 19Cameroon (urban) 14

South Central AmericaPanama 36Paraguay 36Peru (urban) 23Chile (urban) 23Dominican Republic 18

North AmericaUSA 33Barbados 31Mexico 29St Lucia 28Bahamas 28

Eastern MediterraneanJordan 60Qatar 45Saudi Arabia 44Israel 43Lebanon 38

European RegionAlbania 36Malta 35Turkey 29Slovakia 28Czech Republic 26

Obese

0-99

10-149

15-199

20-249

25-299

ge30

Obesityndash Global prevalance

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

One Step-75 g OGTT

Abnorm

Result

Plasma glucose level (mgdl) Prevalance()

CDA gt2 F 95 1 h 190 2h 160 79

EASD gt1 F 108 2 h 162 97

ADA gt2 F 95 1 h 180 2 h 155 106

NZSSD gt1 F 99 2 h 162 176

WHO gt1 F 126 2 h 140 196

ADIPS gt1 F 99 2 h 144 249

ADA American Diabetes Association ADIPS Australasian Diabetes in Pregnancy Society CDA

Canadian Diabetes Association EASD European Association for the Study of Diabetes NZSSD

New Zealand Society for the Study of Diabetes WHO World Health Organization

Diabetes Care 201022676-682

IADPSG

June 2008 Pasadena California

225 conferees from 40 countries reviewed (HAPO) study

HAPO Incidence of Adverse Outcomes for

Glucose Categories (OR 175 or 20 )

Metzger BE et al HAPO NEJM 2008358(19)1991-2002

IADPSG Kriterleri

Coustan DR Paving the way for new diagnostic criteria for GDM 2010

HAPO

One step

Plasma Glucose

Fasting 92 mgdl

1 h 180 mgdl

2 h 153 mgdl

75 G OGTT

GDM 161

Single value

IADPSG 2010

ADA 2012

ES 2013

Obesity and diabetes in USA

South East Asia amp Pacific RegionNauru 78Tonga 70Samoa 63Niue 46French Polynesia 44

AfricaSeychelles 28South Africa 28Ghana 20 Mauritania 19Cameroon (urban) 14

South Central AmericaPanama 36Paraguay 36Peru (urban) 23Chile (urban) 23Dominican Republic 18

North AmericaUSA 33Barbados 31Mexico 29St Lucia 28Bahamas 28

Eastern MediterraneanJordan 60Qatar 45Saudi Arabia 44Israel 43Lebanon 38

European RegionAlbania 36Malta 35Turkey 29Slovakia 28Czech Republic 26

Obese

0-99

10-149

15-199

20-249

25-299

ge30

Obesityndash Global prevalance

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

Diabetes Care 201022676-682

IADPSG

June 2008 Pasadena California

225 conferees from 40 countries reviewed (HAPO) study

HAPO Incidence of Adverse Outcomes for

Glucose Categories (OR 175 or 20 )

Metzger BE et al HAPO NEJM 2008358(19)1991-2002

IADPSG Kriterleri

Coustan DR Paving the way for new diagnostic criteria for GDM 2010

HAPO

One step

Plasma Glucose

Fasting 92 mgdl

1 h 180 mgdl

2 h 153 mgdl

75 G OGTT

GDM 161

Single value

IADPSG 2010

ADA 2012

ES 2013

Obesity and diabetes in USA

South East Asia amp Pacific RegionNauru 78Tonga 70Samoa 63Niue 46French Polynesia 44

AfricaSeychelles 28South Africa 28Ghana 20 Mauritania 19Cameroon (urban) 14

South Central AmericaPanama 36Paraguay 36Peru (urban) 23Chile (urban) 23Dominican Republic 18

North AmericaUSA 33Barbados 31Mexico 29St Lucia 28Bahamas 28

Eastern MediterraneanJordan 60Qatar 45Saudi Arabia 44Israel 43Lebanon 38

European RegionAlbania 36Malta 35Turkey 29Slovakia 28Czech Republic 26

Obese

0-99

10-149

15-199

20-249

25-299

ge30

Obesityndash Global prevalance

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

HAPO Incidence of Adverse Outcomes for

Glucose Categories (OR 175 or 20 )

Metzger BE et al HAPO NEJM 2008358(19)1991-2002

IADPSG Kriterleri

Coustan DR Paving the way for new diagnostic criteria for GDM 2010

HAPO

One step

Plasma Glucose

Fasting 92 mgdl

1 h 180 mgdl

2 h 153 mgdl

75 G OGTT

GDM 161

Single value

IADPSG 2010

ADA 2012

ES 2013

Obesity and diabetes in USA

South East Asia amp Pacific RegionNauru 78Tonga 70Samoa 63Niue 46French Polynesia 44

AfricaSeychelles 28South Africa 28Ghana 20 Mauritania 19Cameroon (urban) 14

South Central AmericaPanama 36Paraguay 36Peru (urban) 23Chile (urban) 23Dominican Republic 18

North AmericaUSA 33Barbados 31Mexico 29St Lucia 28Bahamas 28

Eastern MediterraneanJordan 60Qatar 45Saudi Arabia 44Israel 43Lebanon 38

European RegionAlbania 36Malta 35Turkey 29Slovakia 28Czech Republic 26

Obese

0-99

10-149

15-199

20-249

25-299

ge30

Obesityndash Global prevalance

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

IADPSG Kriterleri

Coustan DR Paving the way for new diagnostic criteria for GDM 2010

HAPO

One step

Plasma Glucose

Fasting 92 mgdl

1 h 180 mgdl

2 h 153 mgdl

75 G OGTT

GDM 161

Single value

IADPSG 2010

ADA 2012

ES 2013

Obesity and diabetes in USA

South East Asia amp Pacific RegionNauru 78Tonga 70Samoa 63Niue 46French Polynesia 44

AfricaSeychelles 28South Africa 28Ghana 20 Mauritania 19Cameroon (urban) 14

South Central AmericaPanama 36Paraguay 36Peru (urban) 23Chile (urban) 23Dominican Republic 18

North AmericaUSA 33Barbados 31Mexico 29St Lucia 28Bahamas 28

Eastern MediterraneanJordan 60Qatar 45Saudi Arabia 44Israel 43Lebanon 38

European RegionAlbania 36Malta 35Turkey 29Slovakia 28Czech Republic 26

Obese

0-99

10-149

15-199

20-249

25-299

ge30

Obesityndash Global prevalance

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

HAPO

One step

Plasma Glucose

Fasting 92 mgdl

1 h 180 mgdl

2 h 153 mgdl

75 G OGTT

GDM 161

Single value

IADPSG 2010

ADA 2012

ES 2013

Obesity and diabetes in USA

South East Asia amp Pacific RegionNauru 78Tonga 70Samoa 63Niue 46French Polynesia 44

AfricaSeychelles 28South Africa 28Ghana 20 Mauritania 19Cameroon (urban) 14

South Central AmericaPanama 36Paraguay 36Peru (urban) 23Chile (urban) 23Dominican Republic 18

North AmericaUSA 33Barbados 31Mexico 29St Lucia 28Bahamas 28

Eastern MediterraneanJordan 60Qatar 45Saudi Arabia 44Israel 43Lebanon 38

European RegionAlbania 36Malta 35Turkey 29Slovakia 28Czech Republic 26

Obese

0-99

10-149

15-199

20-249

25-299

ge30

Obesityndash Global prevalance

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

One step

Plasma Glucose

Fasting 92 mgdl

1 h 180 mgdl

2 h 153 mgdl

75 G OGTT

GDM 161

Single value

IADPSG 2010

ADA 2012

ES 2013

Obesity and diabetes in USA

South East Asia amp Pacific RegionNauru 78Tonga 70Samoa 63Niue 46French Polynesia 44

AfricaSeychelles 28South Africa 28Ghana 20 Mauritania 19Cameroon (urban) 14

South Central AmericaPanama 36Paraguay 36Peru (urban) 23Chile (urban) 23Dominican Republic 18

North AmericaUSA 33Barbados 31Mexico 29St Lucia 28Bahamas 28

Eastern MediterraneanJordan 60Qatar 45Saudi Arabia 44Israel 43Lebanon 38

European RegionAlbania 36Malta 35Turkey 29Slovakia 28Czech Republic 26

Obese

0-99

10-149

15-199

20-249

25-299

ge30

Obesityndash Global prevalance

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

Obesity and diabetes in USA

South East Asia amp Pacific RegionNauru 78Tonga 70Samoa 63Niue 46French Polynesia 44

AfricaSeychelles 28South Africa 28Ghana 20 Mauritania 19Cameroon (urban) 14

South Central AmericaPanama 36Paraguay 36Peru (urban) 23Chile (urban) 23Dominican Republic 18

North AmericaUSA 33Barbados 31Mexico 29St Lucia 28Bahamas 28

Eastern MediterraneanJordan 60Qatar 45Saudi Arabia 44Israel 43Lebanon 38

European RegionAlbania 36Malta 35Turkey 29Slovakia 28Czech Republic 26

Obese

0-99

10-149

15-199

20-249

25-299

ge30

Obesityndash Global prevalance

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

South East Asia amp Pacific RegionNauru 78Tonga 70Samoa 63Niue 46French Polynesia 44

AfricaSeychelles 28South Africa 28Ghana 20 Mauritania 19Cameroon (urban) 14

South Central AmericaPanama 36Paraguay 36Peru (urban) 23Chile (urban) 23Dominican Republic 18

North AmericaUSA 33Barbados 31Mexico 29St Lucia 28Bahamas 28

Eastern MediterraneanJordan 60Qatar 45Saudi Arabia 44Israel 43Lebanon 38

European RegionAlbania 36Malta 35Turkey 29Slovakia 28Czech Republic 26

Obese

0-99

10-149

15-199

20-249

25-299

ge30

Obesityndash Global prevalance

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

Diabesity epidemy 2000 and 2030

Hossain et al NEJM 2007

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

TURDEP I and II studies in Turkey

bull DM and Obesity in 12 years12

ndash DM 90 increased

ndash DM age 5 years earlier

ndash Women 6 kg amp Men 8 kg increased

- Obesity 40 increased (223 312)

19982010

D M Prevalance ()

0

5

10

15

137

72

90

TURDEP I and II 1998 and 2010 population based cross sectional n 24788

1 Satman İ TURDEP Group Diabetes Care 2002251551-6

2 Satman İ Dinccag N TURDEP-II Group 33 Natıonal Congress of Endocrinology 12-16 Oct 2011 Antalya

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

Istanbul Medical FacultyGDM prevalance

Year Deliveries GDM GDM

Prevalance ()

1996- 1998 9544 227 2

1999- 2004 16007 688 43

2005- 2010 12579 732 58

N Dinccedilccedilağ R Has et al 6th International Symposium on Diabetes and Pregnancy 24-26 March Salzburg-Austria 2011

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

CONCLUSIONGDM SCREENING 2015 All Women

bull First visitndash Standart methods

bull Fasting

bull HbA1C

bull Random

(Level B evidence)

bull 24-28 w

ndash Two stepbull 50 and 100mg or

ndash One stepbull 75 gr GTT

bull gt92180153

IAPDPSG 2010 ADA 2011

Standarts of Medical Care in Diabetes Diabetes Care 2012

The Endocrine Society Clinical Practice Guideline 2013

Overt Diabetes (Type 1 or 2)Fasting ge126 mg dL or

HbA1C ge 65

Random plasma glucose ge200 mgdL

Gestational diabetesFasting ge 92 lt126 mgdL

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org

29 ndash 31 Ekim 2015 ndash Harbiye Askeri Muumlze

İstanbul

httpwwwtmftpultrason2015org