Those meeting screening threshold [> 7.8 mmol/L (140 mg/dL)], then proceed to a 3-h, 100 g oral glucose tolerance test (OGTT). Diagnosis is made if at least two of the four OGTT values equal or exceed thresholds of 5.3 mmol/L (195 mg/dL) fasting and 10.0, 8.6, and 7.8 mmol/L (180, 155, or 140 mg/dL, www.selleckchem.com/products/AG-014699.html respectively) at 1, 2 and 3 h, respectively. Outside of the US, WHO criteria are more commonly employed with the diagnosis being made if the plasma glucose exceeds 7 mmol/L (126 mg/dL) fasting or 7.8 mmol/L (140 mg/dL) at 2 h after a 75-g load. To reconcile these differences, a consensus has recommended the
use of identical numerical glucose thresholds at the fasting, 1- and 2-h time points following the 75-g or 100-g OGTT [95, 180, 155 mg/dL (5.3, 10.0, and 8.6 mmol/L)] for diagnosis. The Hyperglycaemia MLN0128 and Pregnancy Outcome study, a recent international observational study of maternal glycemia in pregnancy and birth outcome, may provide the basis
for consensus about protocols for screening for glucose intolerance and criteria for the diagnosis of hyperglycemia in pregnancy. “
“It is recommended that a structured group education programme such as DAFNE (Dose Adjustment For Normal Eating) is offered to all adults with type 1 diabetes. Such programmes teach the skills of carbohydrate counting and insulin dose adjustment with the aim of improving glycaemic control (HbA1c) without increasing the risk of hypoglycaemia. South West Essex Community Services adult
diabetes service was finding that individuals were not accessing the DAFNE programme for various reasons. A diabetes specialist dietitian and nurse decided to pilot the delivery of two 3-hour group sessions to teach some of the basic carbohydrate counting and insulin dose adjustment skills. Changes in HbA1c pre- and post-intervention were reported for 68 subjects. The four second different intervention arms compared were: those who attended just the carbohydrate counting session (n=14), those who attended both sessions (n=24), those who had attended one or both sessions and then went on to attend DAFNE (n=10), and those who had received no carbohydrate counting education (n=20). Those who had attended one or both of the 3-hour sessions had a mean and absolute reduction in HbA1c compared with the group that had not received any education, although this was not statistically significant. The group that had attended one or both of the 3-hour sessions and DAFNE did achieve a statistically significant reduction in HbA1c compared with the group that had not received any education. Despite several identified limitations to the pilot, it was felt that the delivery of the two 3-hour carbohydrate counting and insulin dose adjustment sessions demonstrated some clinically (if not statistically) significant improvement in HbA1c. Copyright © 2013 John Wiley & Sons.