## Diagnosis and Classification **Key Point:** This patient meets diagnostic criteria for gestational diabetes mellitus (GDM). The 2-hour OGTT value of 162 mg/dL exceeds the threshold of 140 mg/dL (or 155 mg/dL depending on protocol), confirming GDM diagnosis at 24 weeks. ## Management Algorithm for Newly Diagnosed GDM ```mermaid flowchart TD A[GDM diagnosed at 24 weeks]:::outcome --> B[Initiate first-line therapy]:::action B --> C[Medical Nutrition Therapy + Lifestyle]:::action C --> D{Blood glucose targets met?}:::decision D -->|Yes| E[Continue monitoring, repeat glucose checks]:::action D -->|No| F[Add pharmacotherapy - Insulin/Metformin]:::action E --> G[Delivery planning at 38-39 weeks]:::outcome F --> G ``` **High-Yield:** First-line management of GDM is **Medical Nutrition Therapy (MNT)** combined with structured self-monitoring of blood glucose (SMBG). Pharmacotherapy is reserved for patients who fail to achieve glycemic targets after 2 weeks of dietary intervention. ## Glycemic Targets in GDM | Measurement | Target (mg/dL) | | --- | --- | | Fasting glucose | < 95 | | 1-hour postprandial | < 140 | | 2-hour postprandial | < 120 | **Clinical Pearl:** This patient has impaired glucose tolerance but is not yet on medication. The standard approach is to counsel on diet (low glycemic index, carbohydrate counting), encourage 30 minutes of moderate exercise daily, and institute home glucose monitoring 4 times daily (fasting + 1 hour after each meal). If targets are not met within 2 weeks, insulin is added. **Tip:** Remember that insulin is the preferred agent in pregnancy (metformin is increasingly used but insulin remains gold standard). Sulfonylureas and DPP-4 inhibitors are avoided in pregnancy. [cite:ACOG Practice Bulletin 190, Obstetric Care Consensus 5]
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