DM Full Guideline (2010) - VA/DoD Clinical Practice Guidelines Home

Version 4.0
B. Refer To Pediatric Diabetes Management
OBJECTIVE
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
Provide appropriate management for children with diabetes.
BACKGROUND
Approximately three-fourths of all newly diagnosed cases of type 1 DM occur in children (below the age of 18).
Children’s healthcare needs are different from those of adults in several ways. Providing healthcare to children not
only must involve meeting their physical needs, but must address their changing developmental stages.
RECOMMENDATIONS
1. Children with diabetes should be referred for consultative care to a pediatric diabetic team that is
knowledgeable and experienced in meeting the medical, psychosocial, and developmental needs of children
with diabetes.
2. The pediatric diabetic team should include a pediatric endocrinologist, if available, and/or a pediatrician,
certified diabetes educator, registered nurse, registered dietitian, and social worker, all with expertise and
specialized training in the comprehensive care of children with diabetes.
C. Is Patient A Female of Reproductive Potential?
OBJECTIVE
Assess the risk of maternal and fetal complications of an unintended pregnancy and implement prevention strategies.
BACKGROUND
The risk of fetal congenital anomalies is directly related to the periconceptual HbA 1 c values. The major determinant
of outcome is the degree of maternal glycemic control before and during pregnancy.
RECOMMENDATIONS
1. All female patients with pre-existing diabetes and reproductive potential should be educated about
contraceptive options, and strongly encouraged to plan and prepare for pregnancy, and to optimize their
glycemic control prior to attempting to conceive.
2. Women with diabetes who are planning pregnancy should be educated about the different options of
diabetes management during the pregnancy and referred to maternal fetal medicine provider before, or as
early as possible, once pregnancy is confirmed.
3. Women with gestational diabetes mellitus (GDM) should be screened for diabetes 6-12 weeks postpartum
and should follow-up with subsequent screening for diabetes or prediabetes (See Module S: Screening)
For management of diabetes during pregnancy – see VA/DOD clinical practice guideline for the management of
pregnancy. (www.healthquality.va.gov or https://www.qmo.amedd.army.mil)
DISCUSSION
Because of the high-risk nature of a diabetic pregnancy and the need for intensive multidisciplinary monitoring and
patient support, referral of women with diabetes to an expert high-risk perinatal team at the earliest possible
opportunity must be considered as the standard of care. Ideally, such a referral should be made during the period of
planned conception.
Nondiabetic pregnancies with maternal HbA 1 c levels below 7.0 mg/dL translate into a 1 to 2 percent risk of fetal
anomalies. For diabetic pregnancies, maternal levels of HbA 1 c above 11 percent result in anomalies in 25 percent of
these pregnancies.
Module D: Core Page 15