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Re: Early glucose screening - So we label themFrom: Henry Gregor (henrygregor@yahoo.com)Sat Nov 6 13:28:01 2004
Peripheral point to the original messge thread, but "...why label...' really resonates with me. For years I have encountered patients who present a personal or family hx of gestational diabetes with the same viewpoint and concern as though it were Type I or II. It is not unusual to encounter a fearful pregnant pt, or grandparent-to-be, significantly stressed because of such a hx or new dx ...better we should call it CHO intolerance of pregnancy, to distance it from the truly signigicant diabetic pregnancies. Also, no doubt many of us have encountered fearful questions from pts scared to death by the comments of other health professionals - to include many, many, dietitians - not particularly conversant with the distinctions re dx, process and obstetric/neonatal outcomes. All too often they (and we) transmit to pts all the worries more properly assigned to pregnancies in those who were diabetic before conception. Glenn's comments re Cochrane review results are very pertinent. Hank Elrod Darryl G MAJ 48 MDOS/SGOBO <Darryl.elrod@LAKENHEATH.AF.MIL> wrote: I'm not sure I agree with saying that skipping the screening test and going to the 'gold standard' in high risk women is appropriate. At least I hope that when I'm a fat 50 yo with high cholesterol and a family history, that my cardiologist doesn't say...sorry pal, you're at risk, how about let's skip the stress test and go to the angiography. According to the ACOG guidelines, there are really very few that aren't at risk. As I've looked at this further, I am beginning to wonder why we test much at all. Not that I'd stop, but a Cochrane review foun little difference in outcomes from treating diabetic women. So we label them, so we tell them about diet, but what are we gaining on the other end? Glen D. Glen Elrod, Maj USAF, MC Obstetrician/Gynecologist Maternal Child Flight 48 MDOS/SGOBO UNIT 5210 Box 23 APO, AE 09464 DSN (314) 226-8334 Comm 01638-52-8334 Notice of Confidentiality Under the Privacy Act of 1974, you must safeguard all information reflected on this Email and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 93-579" This document may contain information covered under the Privacy Act, 5 USC 552(a), and/or the Health Insurance Portability and Accountability Act (PL 104-191) and its various implementing regulations and must be protected in accordance with those provisions. Healthcare information is personal and sensitive and must be treated accordingly. See for full details. -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Steve & Eryl Raymond Sent: Friday, November 05, 2004 8:15 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Early glucose screening In principle as Dan has said, Yes. But in practice, no, those with risk factors get a modified GTT as soon as we see them, because at least 50% of our patients are obese, and they present late, and we are in a resource poor setting. It's not ideal but we do pick those who need more accurate testing. However, I have never advocated a formal GTT anyway, as I prefer to do one hour postprandial levels with fasting and a night time (2200hr) level as my understanding is that it is the abnormal glucose levels that the fetus is exposed to that cause the problem - not the label of "diabetic" or "gestational diabetic". Glucose intolerance is the problem, not some label. All you are ultimately interested in is whether or not the baby is going to become hyperinsulinaemic, not primarily what diagnosis you are going to apply to the mother. Maybe it isn't in line with ACOG guidelines, but it is certainly in the spirit of the ADA assessment. And I have the luxury of not having to defend myself in court! Steve Elrod Darryl G MAJ 48 MDOS/SGOBO wrote:
>But, if you don't screen the at risk population in the early part of Tired of spam? Yahoo! Mail has the best spam protection around
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