Diebetes Gestacional,Clasificación y Dx

Dra. Eliana Cordero Doria Residente de I año de Ginecobstetricia Universidad del Sinú SEPTIEMBRE de 2008 DIABETES GESTACIONAL CLASIFICACIÓN Y DIAGNÓSTICO Dr. RICARDO PAREDES Dr. FREDDY BRICEÑO Docentes UNIVERSIDAD LIBRE FACULTAD DE CIENCIAS DE LA SALUD DEPARTAMENTO DE GINECOLOGIA Y OBSTETRICIA

[object Object],[object Object],[object Object],DIABETES GESTACIONAL CONTENIDO

[object Object],[object Object],[object Object],[object Object],Gómez G. Diabetes y embarazo. Cifuentes R. Obstetricia de alto riesgo. 6ª Ed. 2006, 521-538 DIABETES GESTACIONAL CLASIFICACIÓN

DIABETES GESTACIONAL CLASIFICACIÓN: P risilla White White P. Pregnancy complicating diabetes. Am J Med 1949, 7:609 Landon MB, Catalano P, Gabbe S. Diabetes Mellitus. Gabbe, Niebyl, Simpson Obstetricia 2004, 1081-1116 Clase A Diagnosticada durante el embarazo. A1  Glicemia Pre < 105 A2  Glicemia Pre > 105 Clase B Dx >20 años, < 10 años de evolución. Clase C Dx entre los 10-20 años de edad. Evolución entre 10-20 años. 92% 67% 48%

DIABETES GESTACIONAL CLASIFICACIÓN: P risilla White White P. Pregnancy complicating diabetes. Am J Med 1949, 7:609 Landon MB, Catalano P, Gabbe S. Diabetes Mellitus. Gabbe, Niebyl, Simpson Obstetricia 2004, 1081-1116 Clase D Dx <10 años de edad. Evolución mayor 20 años 32% Clase F Nefropatía. Proteinuria <13% Clase H Cardiopatía Clase R Retinopatía proliferativa Clase T Transplante renal

Gavin III JR, Alberti KG. Report of the Expert Comittee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2003;(Suppl1): S7. DIABETES GESTACIONAL CLASIFICACIÓN: NDDG NOMBRE CARACTERISTICAS TIPO 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],TIPO 2 7-1 0% ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],TIPO 3 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],TIPO 4 90% ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],American College of Obstetricians and Gynecologists. Gestacional Diabetes. ACOG practice bulletin #30, American College of Obstetricians and Gynecologists, Washington, DC 2001 DIABETES GESTACIONAL CLASIFICACIÓN: ACOG

[object Object],[object Object],[object Object],DIABETES GESTACIONAL DIAGNÓSTICO Gómez G. Diabetes y embarazo. Cifuentes R. Obstetricia de alto riesgo. 6ª Ed. 2006, 521-538

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Landon MB, Catalano P, Gabbe S. Diabetes Mellitus. Gabbe, Niebyl, Simpson Obstetricia 2004, 1081-1116 DIABETES GESTACIONAL DIAGNÓSTICO: HISTORIA CLÍNICA Gómez G. Diabetes y embarazo. Cifuentes R. Obstetricia de alto riesgo. 6ª Ed. 2006, 521-538 56%

[object Object],[object Object],Hollander MH, Paarlberg KM, Huisjes AJ. Gestational Diabetes: A Review of the Current Literature and Guidelines. Obstet Gynecol Surv 2007, 62 (2): 125-136 DIABETES GESTACIONAL: cme review article, Holanda Departments of Obstetrics and Gynecology, Antwerpen, Belgium; and Gelre Ziekenhuizen (Hospitals), Apeldoorn, The Netherlands MEDLINE database search with the words “gestational” and “diabetes” for articles published in English 1993-2005

[object Object],[object Object],[object Object],DIABETES GESTACIONAL Hollander MH, Paarlberg KM, Huisjes AJ. Gestational Diabetes: A Review of the Current Literature and Guidelines. Obstet Gynecol Surv 2007, 62(2) 125-136

DIABETES GESTACIONAL Hollander MH, Paarlberg KM, Huisjes AJ. Gestational Diabetes: A Review of the Current Literature and Guidelines. Obstet Gynecol Surv 2007, 62(2) 125-136 ,[object Object],[object Object],[object Object]

[object Object],[object Object],DIABETES GESTACIONAL Hollander MH, Paarlberg KM, Huisjes AJ. Gestational Diabetes: A Review of the Current Literature and Guidelines. Obstet Gynecol Surv 2007, 62(2) 125-136

[object Object],[object Object],[object Object],[object Object],[object Object],Hollander MH, Paarlberg KM, Huisjes AJ. Gestational Diabetes: A Review of the Current Literature and Guidelines. Obstet Gynecol Surv 2007, 62(2) 125-136 DIABETES GESTACIONAL DIAGNÓSTICO: ¿POR QUÉ LA TAMIZACIÓN?

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],B.E. Metzger, D.M. Coustan, Organizing Committee, Summary and Recommendations of the Fourth International Workshop Conference on Gestational Diabetes Mellitus, Diabetes Care (Suppl. 2) (1998) B161–B167. DIABETES GESTACIONAL DIAGNÓSTICO: ¿a quiénes practicar la TAMIZACIÓN? O’Brien, K., Carpenter M. Testing for gestational diabetes .Clin Lab Med 23 (2003) 443–456

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],B.E. Metzger, D.M. Coustan, Organizing Committee, Summary and Recommendations of the Fourth International Workshop Conference on Gestational Diabetes Mellitus, Diabetes Care (Suppl. 2) (1998) B161–B167. DIABETES GESTACIONAL DIAGNÓSTICO: ¿a quiénes practicar la TAMIZACIÓN? O’Brien, K., Carpenter M. Testing for gestational diabetes .Clin Lab Med 23 (2003) 443–456 ,[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],B.E. Metzger, D.M. Coustan, Organizing Committee, Summary and Recommendations of the Fourth International Workshop Conference on Gestational Diabetes Mellitus, Diabetes Care (Suppl. 2) (1998) B161–B167. DIABETES GESTACIONAL DIAGNÓSTICO: ¿a quiénes practicar la TAMIZACIÓN? O’Brien, K., Carpenter M. Testing for gestational diabetes .Clin Lab Med 23 (2003) 443–456

[object Object],[object Object],[object Object],Smirnakis KV, Plati A, Wolf M, et al. Predicting gestational diabetes: choosing the optimal early serum marker. Am J Obstet Gynecol 2007;196:410.e1-410.e7. Smirkanis KV, Martinez A, Blatman KH. Early pregnancy insulin resistance and subsequent gestational diabetes mellitus. Diabetes Care 2005; 28:1207-8. DIABETES GESTACIONAL DIAGNÓSTICO: ¿POR QUÉ LA TAMIZACIÓN? ANTES AHORA

[object Object],[object Object],[object Object],Naylor CD, Semmer M, Chen E, et al: Selective screening for gestational diabetes mellitus. N Engl J Med 1997; 337:1591 DIABETES GESTACIONAL DIAGNÓSTICO: Tamizaje Universal vs Selectivo

[object Object],[object Object],[object Object],E Cosson, M Benchimol, L Carbillon, I Pharisien et al.Universal rather than selective screening for gestational diabetes mellitus may improve fetal outcomes. Diabetes Metab 2006;32:140-146 Crowther C, Hiller J, Moss J, McPhee A, William S, Robinson J, for the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. N Engl J Med 2005;352:2477-86 Griffin ME, Coffey M, Johnson H, et al. Universal versus risk factorbased screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome. Diabet Med 2000;17:26-32 DIABETES GESTACIONAL DIAGNÓSTICO: Tamizaje Universal vs Selectivo

[object Object],[object Object],E Cosson, M Benchimol, L Carbillon, I Pharisien et al.Universal rather than selective screening for gestational diabetes mellitus may improve fetal outcomes. Diabetes Metab 2006;32:140-146 Di Cianni G, Volpe L, Casadidio I, et al. Universal screening and intensive metabolic management of gestational diabetes: cost-effectiveness in Italy. Acta Diabetol 2002;39:69-73 DIABETES GESTACIONAL DIAGNÓSTICO: Tamizaje Universal vs Selectivo

[object Object],[object Object],Smirnakis KV, Plati A, Wolf M, et al. Predicting gestational diabetes: choosing the optimal early serum marker. Am J Obstet Gynecol 2007; 196:410.e1-410.e7. DIABETES GESTACIONAL DIAGNÓSTICO: prueba de tamización (test de O' Sullivan) < 140 mg/dl 140-200 mg/dl > 200 mg/dl Normal Requiere prueba confirmatoria Diagnóstico de Diabetes Gestacional

[object Object],[object Object],Hollander MH, Paarlberg KM, Huisjes AJ. Gestational Diabetes: A Review of the Current Literature and Guidelines. Obstet Gynecol Surv 2007, 62(2) 125-136 DIABETES GESTACIONAL DIAGNÓSTICO: prueba de tamización (Test de O' Sullivan)

O’Sullivan JB, Mahan CM, Charles D, Dandrow RV. Screening criteria for high-risk gestational diabetic patients. Am J Obstet Gynecol 1973;116:895-900. 143 mg/dl O’Sullivan Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982;144:768-73. Carpenter - Coustan 135 mg/dl Metzger BE. Summary and recommendations of the Third International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes 1991;40:197-201. American Diabetes Association. Gestational diabetes mellitus. Diabetes Care 2000;23:S77-9. American College of Obstetricians and Gynecologists. Gestational diabetes. Washington (DC): ACOG; 2001: ACOG Practice Bulletin Number 30 ADA ACOG 140 mg/dl DIABETES GESTACIONAL Test de O' Sullivan: umbral de tamizaje

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DIABETES GESTACIONAL Diagnóstico: RESEÑA HISTÓRICA (CTOG)

[object Object],[object Object],[object Object],[object Object],American Diabetes Association. Standards of medical care in diabetes. Diabetes Care, Volumen 30, Supplement1, January 2007. DIABETES GESTACIONAL Diagnóstico: prueba confirmatoria (CTOG) National Institute of Diabetes and Digestive and Kidney Disease (NIDDK). National Diabetes Data Group. Accessed July 6, 2005. Sangre total O’ Sullivan & Mahan, S&N Plasma venoso N.D.D.G Plasma Venoso Carpenter & Coustan Ayuno 90 105 95 1 hora 165 190 180 2 horas 145 165 155 3 horas 125 145 140

Prueba de tolerancia a la glucosa- 75 g American Diabetes Association. Standards of medical care in diabetes. Diabetes Care, Volumen 30, Supplement1, January 2007 M. Rodacki et al. Can we simplify the 100-g oral glucose olerance test in pregnancy?. Diabetes Research and Clinical Practice 2006;71: 247–250 Diagnóstico 1 o más valores alterados DIABETES GESTACIONAL Diagnóstico: prueba confirmatoria (CTOG) ADA WHO Ayuno 95 ≥ 125 1 Hora 180 2 Horas 155 ≥ 140

Pos-carga 100 gramos de glucosa Cifuentes R B. MD .PhD. Obsetricia de alto riesgo,sexta edicion 2006, 521-38 DIABETES GESTACIONAL Diagnóstico: prueba confirmatoria (HUV) Gómez Tabares G., Revista Colombiana de Ginecología y Obstetricia. 1993, 44: 283-5 Sangre total O’ Sullivan & Mahan, S&N Plasma Venoso Gómez Ayuno 90 90 (89) 1 hora 165 165 (167) 2 horas 145 145 3 horas 125 125 (130)

Gómez Tabares G., Revista Colombiana de Ginecología y Obstetricia. 1993, 44: 283-5 Pos-carga 100 gramos de glucosa DIABETES GESTACIONAL Diagnóstico: prueba confirmatoria (HUV) ICHO DMG Diabetes química Diabetes franca Ayuno normal 1 valor alterado Ayuno normal 2 valores alterados Ayuno anormal < 120mg% Ayuno anormal > 120mg%

[object Object],Standards of medical care in diabetes--2007.(Position Statement)(Disease/Disorder overview). Diabetes Care 2007;30: pS4(38). DIABETES GESTACIONAL Diagnóstico: con un paso ,[object Object],[object Object]

Standards of medical care in diabetes--2007.(Position Statement)(Disease/Disorder overview). Diabetes Care 2007;30: pS4(38). + DIABETES GESTACIONAL Diagnóstico: con dos pasos CTOG con carga de 100 gr 24-28 semanas. Carga de 50gr de glucosa (Test de O ´Sullivan)

[object Object],[object Object],Standards of medical care in diabetes--2007.(Position Statement)(Disease/Disorder overview). Diabetes Care 2007;30: pS4(38). DIABETES GESTACIONAL Diagnóstico: en el post-parto

DIABETES GESTACIONAL Algoritmo Diagnóstico Identificación de factores de riesgo para DMG Primera Consulta Prenatal Alto riesgo de DMG Sin riesgo riesgo de DMG < 90 mg/dl > 126 Glicemia en ayuno Prueba normal CTOG 24 sem. DMG Intoler HC Test de O’Sullivan 50g 24,28 sem glicemia post 1h > 140 ,[object Object],[object Object],[object Object],[object Object]

[object Object],DIABETES GESTACIONAL CONCLUSIONES

[object Object],[object Object],DIABETES GESTACIONAL CONCLUSIONES

[object Object],[object Object],[object Object],DIABETES GESTACIONAL CONCLUSIONES

Diebetes Gestacional,Clasificación y Dx

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