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Management of Diabetes Mellitus by Obstetrician–Gynecologists

Steven G. Gabbe, MD^*, Rebecca Pratt Gregory, MS, RD, Michael L. Power, PhD, Sterling B. Williams, MD and Jay Schulkin, PhD

From the *Vanderbilt University School of Medicine, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine; and Vanderbilt Diabetes Center, Vanderbilt University School of Medicine, Nashville, Tennessee; and Department of Research, American College of Obstetricians and Gynecologists, Washington, DC.

OBJECTIVE: To compare practice patterns of the American College of Obstetrician and Gynecologists (ACOG) Fellows for the diagnosis and treatment of gestational diabetes mellitus (GDM) and type 1 diabetes mellitus with current ACOG recommendations and prior published series.

METHODS: We sent a questionnaire to 1,398 practicing ACOG Fellows and Junior Fellows, 398 of whom comprise the Collaborative Ambulatory Research Network. Responses were evaluated by age and sex to assess differences in practice.

RESULTS: Younger physicians were more likely to treat pregnant patients. Ninety-six percent of obstetricians routinely screen for GDM, nearly all by using a 50-g glucose 1-hour oral test. Nearly 60% of respondents establish the diagnosis of GDM using the National Diabetes Data Group criteria. In addition to medical nutrition therapy, almost 75% of respondents recommend exercise for patients with GDM. Approximately 60% of respondents reported that all of their patients with GDM self-monitor their blood glucose. When medical nutrition therapy is ineffective for their patients with GDM, 82% of respondents initially prescribe insulin, whereas 13% begin with glyburide. Nearly 75% of respondents routinely perform a postpartum evaluation of glucose tolerance in the patient with GDM. Most obstetricians manage the glucose control of their patients with type 1 diabetes mellitus themselves.

CONCLUSION: Practicing obstetrician–gynecologists have incorporated recent recommendations into their practice patterns for both GDM and type 1 diabetes mellitus, including patients’ self-monitoring of blood glucose, exercise, and postpartum testing in GDM.

LEVEL OF EVIDENCE: III

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