SANTISSIMA TRINIDAD HOSPITAL

PINAGBAKAHAN CITY OF MALOLOS, BULACAN

TEL (044) 791 -7331

Issue 6.6 How should we follow up women who develop diabetes during pregnancy?

Postpartum recommendation. A 75-gram oral glucose tolerance test should be done 6-12 weeks
after delivery in GDM women who do not have diabetes immediately postpartum.

An FBS or RBS is not recommended for the long term follow-up and reclassification of women with
previous GDM. However, if patients already have FBS or RBS at the time consultation, thresholds for
DM will be the same as non-pregnant individuals.

Table 6. Metabolic assessments recommended after GDM

Time Test Purpose

Post-delivery (1-3 days) Fasting or random plasma Detect persistent, over diabetes
glucose
Early post-partum (around the 75-gm 2-hr OGTT* Post-partum classification of
time of post-partum visit) glucose metabolism**
1-year post-partum 75-gm 2-hr OGTT Assess glucose metabolism
Annually Fasting plasma glucose Assess glucose metabolism
Tri-annually 75-gm 2-hr OGTT Assess glucose metabolism
Pre-pregnancy 75-gm 2-hr OGTT Classify glucose metabolism

*OGTT Oral glucose tolerance test

**Classification of glucose metabolism by criteria recommended by ADA.

Philippine PRACTICE GUIDELINES FOR DIABETES MELLITUS Part 2:

OPD MANAGEMENT OF TYPE 2 DIABETES MELLITUS

The methodology and framework for the development of the clinical practice guidelines has been
discussed in Screening and Diagnosis.

Question 1. How is diabetes care delivered in the Philippines? How is diabetes care
organized?

1.1 Organization of diabetes care in the Philippines?

In the Philippines, there are several clinical settings where diabetes screening, education and
management can be organized and delivered. For example, at the level of the barangay health
station (BHS), the health worker should have the capability to deliver diabetes self-
management education, do blood pressure and weight/BMI monitoring but it will be at the
level of the RHU/City or Provincial Health Office where diabetes clubs will be encouraged to be
set up. At all levels of health care, education and training will be done so that health care
workers will have the competencies needed for health care workers will have the competencies
needed for health education, screening and management

The strategy will be patient-empowerment; the team should be centered on the person with
diabetes focusing on self-management
 SANTISSIMA TRINIDAD HOSPITAL
PINAGBAKAHAN CITY OF MALOLOS, BULACAN
TEL (044) 791 -7331

1.2 Who comprises the diabetes team?

In the hospital setting, the diabetes can be composed of an organized multidisciplinary
organization: Nurses, pharmacists, diabetes educator, dietitian and dentist, with the physician
(general physician or a diabetes specialist) as the head of the team; others: exercise specialist,
mental health professional (psychologists, psychiatrists, mental health nurses). In the local
health centers (RHU/CHO/BHS), the midwife, primary health nurse or barangay health workers
with adequate training in diabetes education, can serve as the diabetes educators. Lay health
workers or patients who have been instructed on various aspects of diabetes may also deliver
DSME under supervision of the clinic doctor.

Question 2. What should be done during be initial evaluation of a diabetic patient?

2.1 The initial evaluation of the diabetic patient should include a comprehensive medical history
(Table 1) and physical examination (Table 2)

The following points should be elicited in the initial medical history

 Age and characteristic of onset of diabetes (e.g., history of Diabetic ketoacidosis,
asymptomatic laboratory finding)
 Nutritional status and weight history
 Growth and development in children and adolescents
 History of Smoking
 Diabetes education history
 Review of previous treatment regimens and response to therapy (A1C records)
 Current treatment of diabetes: medications, meal plan or eating patterns; physical activity
patterns, and; results of glucose monitoring and patient’s