title: Gestational diabetes mellitus identification based on self-monitoring of blood glucose.
abstract: In Sherbrooke, the gestational diabetes mellitus (GDM) Regional Committee proposed GDM screening during the first trimester for all pregnant women based on a 50 g glucose challenge test (50 g GCT) followed directly by capillary self-monitoring blood glucose (SMBG) at home. We evaluated implementation of committee's recommendations on the clinical trajectory of women receiving prenatal care at our institution. We analyzed data collected systematically by the Blood Sampling in Pregnancy clinic from 2008 to 2011. We evaluated the clinical trajectory of 7710 pregnant women to assess GDM screening/diagnoses and referral rates to the diabetes care centre (DCC) for education and treatment during both the first and second trimesters. The Canadian Diabetes Association glycemic treatment targets in women with GDM were used as diagnosis thresholds and DCC referral decisions: Fasting glucose of 5.3 mmol/L and postprandial 2 h glucose of 6.7 mmol/L. We found that pregnant women were 28.0±4.8 years old, and their body mass indexes were 24.5±5.5 kg/m(2). During the first trimester, 47% of women were screened for GDM, mostly (84%) using the 50 g GCT. Following SMBG, 5.7% were referred to the DCC. Only 32% of women with early GDM had >1 GDM risk factor. Thereafter, 67% of normoglycemic women screened during the first trimester were screened again during the second trimester. Among women screened during the second trimester, most screening was done using 50 g GCT, and 8.8% were referred to the DCC following SMBG. Implementation of 50 g GCT testing followed by direct home SMBG was well implemented in our area. The importance of early GDM screening and rescreening during the second trimester still needs to be emphasized.
authors.affiliation: Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Allard
authors.affiliation: Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Elie
authors.initials: E
authors.lastname: Sahyouni
authors.affiliation: Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Menard
authors.affiliation: Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Houde
authors.affiliation: Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Pesant
authors.affiliation: Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Patrice
authors.initials: P
authors.lastname: Perron
authors.affiliation: Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Ouellet
authors.affiliation: Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Obstetrics and Gynecology, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Moutquin
authors.affiliation: Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Ardilouze
authors.affiliation: Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA. Electronic address: marie-france_hivert@harvardpilgrim.org.
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Hivert
mesh_terms: D000328:Adult; D015190:Blood Glucose Self-Monitoring; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D011792:Quebec; D055815:Young Adult
keywords: clinical management; diabète gestationnel; diminution de la tolérance au glucose; dépistage; gestational diabetes mellitus; home capillary blood glucose monitoring; impaired glucose tolerance; primary care; prise en charge clinique; screening; soins primaires; surveillance de la glycémie capillaire à domicile