Diabetes in Pregnancy and Special Populations Flashcards

For a woman with diabetes who is planning pregnancy, which A1C target is recommended if it can be reached without significant hypoglycemia?

Answer: Below 6.5%

ADA Standards of Care recommend a preconception A1C below 6.5% when it can be achieved safely. This lowers the risk of congenital anomalies and other adverse outcomes. An A1C below 5.0% would carry a high risk of hypoglycemia, and targets of 7.5% or above are too high for pregnancy planning.

Which set of glucose targets is recommended during pregnancy complicated by diabetes?

Answer: Fasting below 95 mg/dL, 1-hour postprandial below 140 mg/dL, or 2-hour postprandial below 120 mg/dL

ADA recommends fasting glucose below 95 mg/dL, with 1-hour postprandial below 140 mg/dL or 2-hour postprandial below 120 mg/dL. Fetal outcomes depend on tight glycemic control, so these targets are much stricter than those for non-pregnant adults.

When is routine screening for gestational diabetes mellitus (GDM) typically performed in a woman without known diabetes?

Answer: At 24–28 weeks of gestation

Screening with an OGTT is recommended at 24–28 weeks of gestation. This is when placental hormones raise insulin resistance enough to unmask GDM. Women at high risk may be screened earlier, at the first prenatal visit.

A patient with type 2 diabetes takes lisinopril, metformin and atorvastatin and tells you she wants to become pregnant. Which medication change should you flag for her provider?

Answer: Discontinue the ACE inhibitor (lisinopril) and the statin before conception

ACE inhibitors, ARBs and statins are generally stopped before conception or as soon as pregnancy is confirmed because of fetal risk. Insulin is the preferred agent for glycemic management in pregnancy. Metformin use is decided individually by the provider.

Which A1C goal is generally appropriate for an older adult with multiple coexisting chronic illnesses or mild-to-moderate cognitive impairment (complex/intermediate health)?

Answer: Below 8.0%

ADA suggests an A1C goal below 8.0% for older adults with complex or intermediate health. Healthy older adults have a tighter goal, below 7.0–7.5%. For those in very poor health, the priority is avoiding hypoglycemia and symptomatic hyperglycemia. Treatment is de-intensified to reduce the risk of hypoglycemia.

What is the general A1C goal recommended for most children and adolescents with type 1 diabetes, provided it can be reached without excessive hypoglycemia?

Answer: Below 7.0%

ADA and ISPAD recommend an A1C below 7% for most children and adolescents with type 1 diabetes if it is achievable without excessive hypoglycemia. The goal can be individualized, for example for children with hypoglycemia unawareness.