## Diagnosis and Interpretation **Key Point:** The 75 g OGTT diagnostic criteria for gestational diabetes mellitus (GDM) in India follow the WHO 2013 recommendations: - Fasting: ≥92 mg/dL (abnormal) - 1-hour: ≥180 mg/dL (abnormal) - 2-hour: ≥153 mg/dL (abnormal) This patient has **one abnormal value** (fasting 95 mg/dL and 2-hour 155 mg/dL are above thresholds), meeting diagnostic criteria for GDM. ## Management Algorithm for Newly Diagnosed GDM ```mermaid flowchart TD A[OGTT Result: ≥1 abnormal value]:::outcome --> B[GDM Diagnosed]:::outcome B --> C[Initiate Medical Nutrition Therapy]:::action C --> D[Home Blood Glucose Monitoring]:::action D --> E{Glycemic Control Achieved?}:::decision E -->|Yes| F[Continue MNT + HBGM]:::action E -->|No| G[Add Insulin/Metformin]:::action F --> H[Deliver at 39 weeks]:::action G --> H ``` ## First-Line Management **High-Yield:** Medical nutrition therapy is the **first-line and most appropriate initial step** for all newly diagnosed GDM cases, regardless of severity. This includes: 1. Dietary counseling (carbohydrate counting, portion control, low glycemic index foods) 2. Home blood glucose monitoring (fasting and 2-hour postprandial) 3. Review results in 1 week **Clinical Pearl:** Approximately 80–85% of GDM cases are managed with MNT alone without requiring pharmacotherapy. Insulin is added only if target glucose levels are not achieved after 2 weeks of MNT. ## Target Glucose Levels in GDM | Parameter | Target (mg/dL) | |-----------|----------------| | Fasting | <95 | | 1-hour postprandial | <140 | | 2-hour postprandial | <120 | **Key Point:** Early review (1 week) allows timely escalation to pharmacotherapy if needed, balancing maternal and fetal safety. [cite:ICMR-INDIAB GDM Guidelines 2018]
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