Management of Diabetes Mellitus by Obstetrician–Gynecologists


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Abstract

OBJECTIVE:To compare practice patterns of the American College of Obstetrician and Gynecologists (ACOG) Fellows for the diagnosis and treatment of gestational diabetes mellitus (GDM) and type 1 diabetes mellitus with current ACOG recommendations and prior published series.METHODS:We sent a questionnaire to 1,398 practicing ACOG Fellows and Junior Fellows, 398 of whom comprise the Collaborative Ambulatory Research Network. Responses were evaluated by age and sex to assess differences in practice.RESULTS:Younger physicians were more likely to treat pregnant patients. Ninety-six percent of obstetricians routinely screen for GDM, nearly all by using a 50-g glucose 1-hour oral test. Nearly 60% of respondents establish the diagnosis of GDM using the National Diabetes Data Group criteria. In addition to medical nutrition therapy, almost 75% of respondents recommend exercise for patients with GDM. Approximately 60% of respondents reported that all of their patients with GDM self-monitor their blood glucose. When medical nutrition therapy is ineffective for their patients with GDM, 82% of respondents initially prescribe insulin, whereas 13% begin with glyburide. Nearly 75% of respondents routinely perform a postpartum evaluation of glucose tolerance in the patient with GDM. Most obstetricians manage the glucose control of their patients with type 1 diabetes mellitus themselves.CONCLUSION:Practicing obstetrician–gynecologists have incorporated recent recommendations into their practice patterns for both GDM and type 1 diabetes mellitus, including patients’ self-monitoring of blood glucose, exercise, and postpartum testing in GDM.LEVEL OF EVIDENCE:III

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