## Diagnosis and Classification **Key Point:** This patient meets diagnostic criteria for gestational diabetes mellitus (GDM). According to IADPSG (International Association of Diabetes and Pregnancy Study Groups) criteria adopted in India, ONE abnormal value on 75 g OGTT is diagnostic of GDM: - Fasting ≥92 mg/dL, OR - 1-hour ≥180 mg/dL, OR - 2-hour ≥153 mg/dL This patient has abnormal 1-hour (185 mg/dL) and 2-hour (155 mg/dL) values, confirming GDM diagnosis. ## Management Algorithm for Confirmed GDM ```mermaid flowchart TD A[GDM Diagnosed on OGTT]:::outcome --> B[Initiate Lifestyle Intervention]:::action B --> C[Dietary counseling + Exercise]:::action B --> D[Self-monitoring of Blood Glucose]:::action C --> E{Glycemic targets achieved?}:::decision D --> E E -->|Yes| F[Continue monitoring, repeat glucose checks]:::action E -->|No| G[Add Pharmacotherapy - Insulin/Metformin]:::action F --> H[Fetal assessment at 28-32 weeks]:::action G --> H ``` **High-Yield:** First-line management of GDM is always **medical nutrition therapy (MNT) + lifestyle modification + self-monitoring of blood glucose (SMBG)**. Insulin or metformin is added only if glycemic targets are not achieved after 1–2 weeks of lifestyle intervention. ## Glycemic Targets in GDM | Parameter | Target (mg/dL) | | --- | --- | | Fasting | 95 | | 1-hour postprandial | 140 | | 2-hour postprandial | 120 | **Clinical Pearl:** Approximately 80% of GDM cases are managed with diet and exercise alone. Pharmacotherapy is reserved for those with persistent hyperglycemia despite optimal lifestyle modification. **Tip:** The next step is NOT to repeat OGTT (diagnosis is already established), start insulin immediately (without first attempting lifestyle intervention), or perform detailed fetal assessment at 24 weeks (fetal biometry and Doppler are indicated at 28–32 weeks for growth assessment).
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