Updates in Managing Gestational Diabetes

Executive Summary

Gestational Diabetes is directly linked to adverse health risks for mothers and neonates. It predisposes mothers to higher risks of developing type 2 diabetes. The most reliable modality of diagnosing and managing GDM is a highly debated topic whereas the significance of oral antidiabetic medications in treatment remains unestablished.

Updates in Managing Gestational Diabetes

This paper reviews the approaches to diagnosing GDM, recent advances in GDM treatment, and interventions to decrease the likelihood of developing type 2 diabetes in women with GDM.

The population of Salt Lake City, Utah is 197 756 by the 2019 Census. The health determinants of its residents reflect those of an urban city, with the prevalent diseases being primarily lifestyle-associated diseases, such as diabetes mellitus, obesity, dyslipidemias, and the metabolic syndrome X.

The prevalence of gestational diabetes has increased remarkably from 1.5 % in 1997 to 6.1% in 2019(Utah gov, 2020). Using more effective diagnosing, treatment and intervention would significantly reduce the disease’s prevalence and its associated complications. It is expected to culminate in lower numbers of non-elective caesarian section deliveries necessitated by fetuses weighing above four thousand grams.

This paper proposes screening for GDM between 24 to 28 weeks of gestation by 75-g, 2-hour oral glucose tolerance testing. The benefits of this screening protocol are it recognizes milder levels of hyperglycemia, allowing for treatment that culminates in reduced adverse events in pregnancy and neonatal outcomes (Dickens & Thomas, 2019).

Policymakers could implement the afore-mentioned screening strategy to achieve the desired health outcomes in pregnant women with gestational diabetes. Also, policymakers could facilitate the application of telemedicine to manage women with GDM and prevent the progression of the disease, via tools such as smartphone applications and online diabetes prevention program. Also, insurance policies ought to be reviewed to meet the needs of the larger proportion of Salt Lake’s population.

Context and Scope

The responsibility of primarily improving health differs slightly in perspectives amongst patients, employers, and physicians. Also, the proportion of Utah’s population that has is below the poverty line is approximately a third. About a fifth of the population has educational attainment below a high school graduate while another fifth are high school graduates.

A third have a college degree or associate degree while another third has a bachelor’s degree or higher. The population may well be grouped into those living within standard incomes and below poverty. Of those living below poverty, 21.0 % have attained education of less than a high school graduate, 28.5 % have qualifications of a high school graduate or equivalent, 34.1 5 have a college or associate degree while 16.3 % have a Bachelor’s degree (Gardner, 2018).

The proportion living within standard income has 8.4 % qualifying for less than a high school graduate, 22.9 % being high school graduates or equivalents, 36.8% have a college or associate degree while 31.9 % have a Bachelor’s degree. Non-Hispanic Whites comprise 59 % of Utah’s population while 41 % comprise of the minority, namely Non-Hispanic Black, Hispanic, Non-Hispanic Asian, Non-Hispanic Hawaiian or Pacific Islander, and Non-Hispanic Native Two or More Races.

The women with gestational diabetes are white Caucasian, South Asian, East Asian, Black, Filipina, Middle Eastern, and Hispanic. Non-Caucasians had a GDM diagnosed at a younger age than Caucasian women and also had a higher likelihood of having a positive family history of diabetes (Read et al., 2019).

Additional findings indicate that non-Caucasian women had a higher probability of being overweight by ethnic-specificity body mass index cutoffs. Non-Caucasian women also had higher oral glucose tolerance test values.

Policymakers for GDM include the American Diabetes Association, the International Association of the Diabetes and Pregnancy Study Groups, and the Endocrine Society. The current policy recommended is screening between 24 to 28 weeks of gestation using 75-g, 2-hour oral glucose tolerance testing. The aim of the strategy is primarily to identify the mild levels of hyperglycemia to decrease adverse health events during pregnancy and delivery.

While the policy provides the appropriate screening guidelines, it falls short of catering to the medical costs of the target population. About 33.1 % live below poverty while 21.0 % of those have less than a high school education (Gardner, 2018).

The lower the level of education makes it more challenging to secure stable employment and afford medical insurance. Therefore, although the set policy would protect women against GDM, the services would only be enjoyed by the women who afford the costs. The policy leaves other women unattended, such as those without stable sources of income or a reliable health insurance plan (Utah gov, 2020). The provision of universal health coverage is among the principal tenets of the millennial development goals.

Universal health coverage encompasses easily accessible health services to all human beings on earth, regardless of income or social status. Providing diagnosis, management, and intervention of GDM to expectant women of the entire population would be a milestone attained towards achieving the millennial developmental goals.

Demographics Table

(Place Title of SDOH here) Statistics/facts Summary of statistics/facts Source for statistics/facts
Demographic Information(Provide 2 or more  statistics/facts associated with demographics for SDOH in the column to the right) 

 

Prevalence of Gestational Diabetes 1.5 % in 1997 Fewer women were diagnosed with Gestational Diabetes in previous decades, most likely due to less sensitive screening tests. Utah’s Public Health Data Resource
Prevalence of Gestational Diabetes 6.1% & in 2019 More women have been diagnosed with gestational diabetes over the recent decade. The rise is attributable to the increased sensitivity of screening tests. Utah’s Public Health Data Resource
Risk Factors(Provide 2 or more statistics/facts regarding risk factors associated with SDOH in the column to the right). 

 

Ethnicity    

 

Non-Caucasian women have higher risks of developing GDM. Characteristics of Women With Gestational Diabetes From Non-Caucasian Compared With Caucasian Ethnic Groups (Read et al., 2019)
Socioeconomic status Women of lower socioeconomic status have higher risks for developing GDM and obesity Policy Institute, The University of Utah(Gardner, 2018)
Trends in SDOH Over Recent Year(s)(Provide 2 or more statistics/facts associated with trends in SDOH over a recent year(s) in the column to the right.) The prevalence of Gestational DiabetesHas increased to 6.1 % in 2019. 

 

 

The increase in GDM prevalence is attributable to increased sensitivity of screening tests and increasingly sedentary lifestyles. Utah’s Public Health Data Resource
 

Policy Proposal and Implementation Plan

Two policy alternatives are suitable to adequately mitigate the problem of inequality in health care access. The first approach is to make antenatal care and delivery of the infant completely free of charge for all mothers. Making the services free of charge would attract multiple women to readily seek the health services while pregnant, which would result in GDM being detected early, together with other illnesses (ADA, 2020).

Appropriate measures could then be sought to manage, treat and provide intervention for the specific health hazard. Making the services free to all women would translate to the government directly providing the financial resources required (Steenhuysen, 2020).

The second alternative would be to subsidize the costs of antenatal care and delivery for the mothers. This policy would be possible through the government making timely payments to health facilities to cater for antenatal care and delivery costs, enabling the majority of American mothers to access the services.

In my opinion, the preferred policy is making antenatal care services and delivery free of charge. This policy would encourage more Americans to easily access healthcare, particularly those living below the poverty line. I would prefer the policy to the other of subsidizing the costs.

While subsidization would make the health services affordable to the middle class and first-class individuals, still poor mothers would find it challenging to meet the subsidized costs (Gardener, 2018).  This observation is attributable to the fact that poor persons often find it difficult to fend for themselves by attaining the basic needs of food, shelter, and clothing. Whether they would be able to attain subsidized healthcare fees remains highly unlikely.

The implications of the new policy in optimizing health within Salt City cannot be overemphasized. To begin with, providing accessible health care to poor mothers would promote positive health-seeking behavior. This notion stems from the fact that the majority of poor persons avoid going to hospital owing to the increased costs of healthcare.

Whereas health insurance costs are purported to make healthcare more affordable to all population groups, the benefits often miss out on the poor as they are obliged to choose between having meals, decent shelter, and clothing and acquiring an all-inclusive health insurance plan.

The financial costs of the proposed policy alternative would be hefty for the government. The cost of care for pregnancy and the newborn in the United States averages at   $ 30 000 for vaginal delivery and $ 50 000 for Cesarean section. Insurers pay an average of $ 18 329 and $ 27 866 (Steenhuysen, 2020).

Thus, even insured mothers have to pay the extra costs out of their own pockets. Where the health insurance plan is provided by the employer, the plans pass by some payments in the form of deductibles and copayments, which results in the cost of delivery through employer-offered insurance rising to $ 4 564 in 2015 from $ 3 069 in 2008.

Nonetheless, benefits of the proposed policy alternative include early diagnosis of GDM; and timely management and intervention culminating in reduced maternal mortality rates related to GDM and reduced adverse neonatal outcomes such as macrosomia and later-life diabetes.

Ethical implications of the proposed policy alternative include justice and autonomy. A larger proportion of poor mothers is unable to meet the costs of antenatal care and delivery out of their own pockets (Steenhuysen, 2020), which restricts their autonomy over personal health needs.

This observation is a direct violation of the principle of autonomy in inpatient care. Regarding justice, critical health services should be made available and accessible to all persons within the population, concerning the severity of the health needs.

Since the majority of poor mothers are unable to access antenatal care and delivery services owing to their rising costs, the principle of justice is violated regarding their health needs. The rising costs of antenatal care and delivery bars expectant mothers from early diagnosis of GDM, together with its treatment, and intervention.

Barriers to the implementation of the proposed health policy are diverse. To begin with, the rising healthcare costs would be particularly discouraging to the federal and state governments, which would have to direct the financial resources from another sector of the nation’s economy. Also, insurers are highly unlikely to reduce their cover prices to lower the costs of antenatal care and delivery as that would result to lower profit margins.

The communication models that could be employed to introduce the policy include print-media such as newspapers, health journals, and magazines; roadside billboards, and online advertising platforms such as on social media.

The inaction of the proposed policy would result in elevated maternal mortality rates from undiagnosed GDM since the prevalence of GDM is increasing annually. Also, inaction would translate to the poor expectant mothers’ continued inaccessibility to quality health services.

Reflection

During my community attachment studies, I actively participated in screening expectant women for gestational diabetes mellitus. My studies revealed that earlier forms of screening left mild forms of the disease undetected, which necessitated a change of policy to incorporate the guidelines recommended by the American Diabetes Association, the International Association of the Diabetes and Pregnancy Study Groups, and the Endocrine Society.

Among my observations was that the majority of persons living below the poverty line are unable to afford quality healthcare, besides other basic needs (Utah gov, 2020). I hence sought to devise a means that would provide universal health coverage to all persons within the population, particularly the poor.

The knowledge and skills that are vital to influencing policy development decision-making include assessment of community-health needs, problem-solving techniques in response to the community health needs, and proper communication skills with concerned parties.

Updates in Managing Gestational Diabetes References

  • American Diabetes Association, ADA (2020). Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2020. American Diabetes Association Diabetes Care 43(1): S183-S192. Retrieved from  https://pubmed.ncbi.nlm.nih.gov/31862757/183 at 2213 H GMT on 21st January 2021.
  • Dickens, L. T., & Thomas, C. C. (2019). Updates in gestational diabetes prevalence, treatment, and health policy. Current diabetes reports19(6), 33. Retrieved from /link.springer.com/article/10.1007%2Fs11892-019-1147-0 at 0408 H GMT, 22nd January 2021.
  • Gardner, K.C. (2018) Data Points Social Determinants of Health. Policy Institute, The University of Utah. Pp 1-12. Retrieved from gardner.utah.edu/wp-content/uploads/Aug2018SymposiumData.pdf at 0222 H GMT, 22nd January 2021.
  • Read, S., Wu, W. Ray, J, Lowe, J. Feig, S. & Lipscombe, L. (2019). Characteristics of Women with Gestational Diabetes from  Non-Caucasian Compared with Caucasian Ethnic Groups. National Library of Medicine, 43 (8): 600-605. Retrieved from  pubmed.ncbi.nlm.nih.gov/31679964/ at 1900 H GMT 21st January 2021.
  • Steenhuysen, J. (2020) Even for Insured Women, Having a Baby in the United States is Costly. Healthcare and Pharma, Reuters. Retrieved from  www.reuters.com/article/us-health-maternity-costs/even-for-insured-women-having-a-baby-in-the-u-s-is-costly-idUSKBN1Z7300 at 0133 H GMT on 22nd January 2021.
  • Utah gov (2020) Public Health Indicator-Based  Information System (IBIS). Utah’s Public Health Data Resource.  Retrieved from ibis.health.utah.gov/ibisph-view/indicator/complete_profile/DiabGestDiab.html#:~:text=Percentage%20of%20Utah%20Birth%20Records,6.1%20percent%20of%20birth%20records at 0633 H GMT, 22nd January 2021.

Updates in Managing Gestational Diabetes Instructions

  Exam Content  Case Study  Read the following case study:  Sue is an RN who has been practicing for 3 years and typically works in labor and delivery, and she volunteers at a clinic that serves diabetic OB patients. She encounters two patients, one who has developed gestational diabetes and the other who has been diabetic her entire life.    While working on her normal shift in labor and delivery, Sue is in charge of a student nurse who will be graduating in 2 weeks and assigns this nurse to the newly admitted patient with gestational diabetes. The patient started having contractions about 2 hours ago that are now 2–3 minutes apart, lasting approximately 10–15 seconds.   Assignment  Create a concept map showing Benner\'s stages from novice to expert and its alignment to the nursing process for an improved nursing care plan.  Write a 525- to 700-word summary explaining the concept map and how the concepts in Benner’s theory relate to the nursing process, including alignment with critical thinking and clinical decision-making for an improved nursing care plan. In addition, address the following:  Define each stage on the continuum and describe the characteristics associated with each stage. Include setting, patient needs, level of understanding, and complexities that may contribute to increased risks. Explain where you fall on the continuum. Where do Sue and the student nurse fall? Include an explanation to why you placed each stage in the specific area. Use this information to develop a personalized nursing theory or model for the above scenario to address the care needed for each patient.  Use visual presentation software from the College of Education Technology Resource Library to create your concept map. To review your options, do the following:  Select Web Tools in the Table of Contents. Select Collaboration & Productivity from the list of tools. Include at least 2 scholarly resources from the University Library to support you work.