Promoting health after gestational diabetes: a National Diabetes Education Program call to action.

The National Diabetes Education Program joins the American College of Obstetricians and Gynecologists (the College) to promote opportunities for obstetrician-gynecologists (ob-gyns) and other primary care providers to better meet the long-term health needs of women with prior gestational diabetes mellitus (GDM) and their children. Up to one third of GDM women may have diabetes or prediabetes postpartum, yet only about half of these women are tested postpartum, and about a quarter are tested 6-12 weeks postpartum. Women with GDM face a lifelong increased risk for subsequent diabetes, primarily type 2 diabetes mellitus. Timely testing for prediabetes may provide an opportunity for ob-gyns to prevent or delay the onset of type 2 diabetes mellitus through diet, physical activity, weight management, and pharmacologic intervention. The College and the American Diabetes Association recommend testing women with a history of GDM at 6-12 weeks postpartum. If the postpartum test is normal, retest every 3 years and at the first prenatal visit in a subsequent pregnancy. If prediabetes is diagnosed, test annually. Because children of GDM pregnancies face an increased risk for obesity and type 2 diabetes mellitus, families need support to develop healthy eating and physical activity behaviors. Current criteria indicate that GDM occurs in 2% to 10% of all pregnancies. If new GDM diagnostic criteria are used, the frequency of GDM may increase to about 18% of pregnancies annually. The projected increase in the number of women with GDM and the potential subsequent associated risks underscore the need for proactive long-term primary care treatment of the mother and her children.

Management of type 2 diabetes in youth: an update.

Although type 1 diabetes historically has been more common in patients eight to 19 years of age, type 2 diabetes is emerging as an important disease in this group. Type 2 diabetes accounts for 8 to 45 percent of new childhood diabetes. This article is an update from the National Diabetes Education Program on the management of type 2 diabetes in youth. High-risk youths older than 10 years have a body mass index greater than the 85th percentile for age and sex plus two additional risk factors (i.e., family history, high-risk ethnicity, acanthosis nigricans, polycystic ovary syndrome, hypertension, or dyslipidemia). Reducing overweight and impaired glucose tolerance with increased physical activity and healthier eating habits may help prevent or delay the development of type 2 diabetes in high-risk youths. The American Academy of Pediatrics does not recommend population-based screening of high-risk youths; however, physicians should closely monitor these patients because early diagnosis may be beneficial. The American Diabetes Association recommends screening high-risk youths every two years with a fasting plasma glucose test. Patients diagnosed with diabetes should receive self-management education, behavior interventions to promote healthy eating and physical activity, appropriate therapy for hyperglycemia (usually metformin and insulin), and treatment of comorbidities.

Reducing cardiovascular disease risk in patients with diabetes: a message from the National Diabetes Education Program.

PURPOSE: To provide nurse practitioners (NPs) a review of current practice guidelines that help clinicians' efforts to reduce the morbidity and mortality associated with diabetes and its major macrovascular complications. DATA SOURCES: This paper presents data from major evidence-based studies and clinical trials that define the scope of the problem, the rationale for risk reduction, and a patient-centered action plan for NPs to effectively manage cardiovascular risk factors in people with diabetes. CONCLUSIONS: NPs are active partners with the National Diabetes Education Program and play a key role in efforts to effectively manage cardiovascular risk factors in people with diabetes and improve their awareness of the link between diabetes and heart disease and stroke. IMPLICATIONS FOR PRACTICE: The action plan to reduce cardiovascular risk in people with diabetes will help NPs to implement the most effective management strategies for medical nutrition therapy, physical activity, and pharmacological therapy required for patient-centered proactive management of hyperglycemia, hypertension, and lipid abnormalities.

Diabetes and physical activity in school.

Physical activity and exercise are critical components of diabetes management. Everyone can benefit from regular exercise, but it is even more important for a student with diabetes. In addition to maintaining cardiovascular fitness and controlling weight, physical activity can help to lower blood glucose levels and increase insulin sensitivity. With the nearly epidemic incidence of childhood obesity and type 2 diabetes in youth, physical education should be part of the school day for all children. Students with diabetes should participate fully in physical education classes and team sports. To maintain blood glucose levels within their target ranges during exercise, students with type 1 diabetes will make adjustments in their insulin and food intake. To prevent hypoglycemia, they also will need to check their blood glucose levels more frequently while engaging in physical activity. Physical education instructors and sports coaches must be able to recognize and assist with the treatment of hypoglycemia. A quick-acting source of glucose and the student's glucose meter should always be available, along with water. The student's Diabetes Medical Management Plan, nursing care plan, 504 Plan, IEP, or other education plan should include specific instructions.

Reducing cardiovascular disease risk in patients with type 2 diabetes: a message from the National Diabetes Education Program.

Cardiovascular disease is responsible for 65 percent of deaths in persons with type 2 diabetes. However, awareness of cardiovascular disease risk factors among patients with diabetes remains low, resulting in missed opportunities to lower risks for coronary events and strokes. The National Diabetes Education Program has begun a campaign to increase patient participation in risk-reduction practice s by promoting the "ABCs" of diabetes care: A(1c) level, Blood pressure, and Cholesterol level. By increasing patient awareness of the link between diabetes and heart disease, family physicians can encourage patients to take medications (including aspirin), stop smoking, lower blood pressure, and lower cholesterol and blood glucose levels.