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Di Cianni G.,UOC Diabetologia e Malattie del Metabolismo | Lacaria E.,University of Pisa | Russo L.,UOC Diabetologia e Malattie del Metabolismo | Sannino C.,UOC Diabetologia e Malattie del Metabolismo
Giornale Italiano di Diabetologia e Metabolismo | Year: 2013

For many decades there have been differences of opinion about gestational diabetes mellitus (GDM) screening in Italy. It has now become essential to standardize both the methods of treatment and the techniques for GDM management, using shared clinical pathways. Unfortunately, the literature and international recommendations about obstetric and metabolic monitoring are scanty. There are therefore no specific guidelines about GDM management: therapeutic targets, glycemic control, HbA1c, frequency of diabetological and gynecological visits, ultrasound monitoring, etc. A first attempt to coordinate interventions in this area is the GDM care pathway of the Tuscany Region, established by a group of experts. The main feature of this clinical pathway is the "team", made up of people with different medical skills, working together in diabetes-obstetrics outpatient clinics. Source


Di Cianni G.,UOC Diabetologia e Malattie del Metabolismo | Lacaria E.,Azienda Ospedaliero Universitara Pisana | Lencioni C.,UOC Diabetologia e Malattie del Metabolismo | Russo L.,UOC Diabetologia e Malattie del Metabolismo | Bertolotto A.,Azienda Ospedaliero Universitara Pisana
Giornale Italiano di Diabetologia e Metabolismo | Year: 2015

The Italian National Health System guidelines recommend gestational diabetes mellitus (GDM) screening only for women with risk factors. They now recommend a screening test (OGTT 75 g 2 hours) early in pregnancy (16-18 weeks) for women at high risk (HR: previous GDM; pre-pregnancy BMI ≥ 30 kg/m2, blood glucose at first visit in pregnancy 100-125 mg/dl) and later in pregnancy (24-28 weeks) for women at medium risk (MR: pre-pregnancy BMI 25-30 kg/m2, age ≥ 35 years, previous macrosomia; family history of type 2 diabetes, ethnic group with a high prevalence of diabetes); women at low risk (LR: no risk factors) do not need screening. The present study assessed whether the new national guidelines (NGL) are applied correctly and analyzed the effectiveness of GDM diagnosis according to risk factor profile. We classified a cohort of 2552 pregnant Caucasians (age 32 ± 5 years; family history of type 2 diabetes 18.2%; pre-pregnancy BMI 22.8 ± 4 kg/m2) consecutively screened for GDM according to the NGL in two Tuscan centers in 2012-13. Out of 98 LR women (3.8%), two (1.6%) had an OGTT at an early stage and the remaining 96 (98.4%) were tested later. MR women (2193) accounted for 86% and almost all were screened late (98.4%). The remaining 10.2% (261) were HR women, only 7% of whom were screened early, and 93% later. GDM was diagnosed in 279 cases, with a prevalence of 10.9%. The incidence of GDM was 4.1% in LR women (4 cases), 8.98% in MR women (197), and 29.8% in HR women (78). The prevalence based on the NGL was therefore 10.9%, 25% more than the figure given by the old criteria ten years earlier. In conclusion, these findings indicate that the NGL recommendations are still inadequately applied, especially as regards early screening for HR women. The difference in the prevalence of GDM estimated with the new criteria is very close to that recorded in other Italian regions. © 2015 UTET Periodici Scientifici srl. All rights reserved. Source

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