Friday 29 November 2013

Gestational diabetes - classifications

Classifications:
National Diabetes Data Group:
1. Type I diabetes mellitus - Immune mediated Idiopathic
2. Type II diabetes mellitus 3.Gestational diabetes mellitus

Other specific types of diabetes
a) Genetic defects of beta – cell function
b) Genetic defects in insulin action c) Disease of excrocrine pancreas
d) Drug or Chemical induced
e) Infections
f) Uncommon forms of immune- mediated diabetes
g) Other genetic syndromes associated with diabetes.


Priscilla White's Classification of diabetes during pregnancy: Gestational diabetes - Discovered during pregnancy, glycemia may or may not be maintained by diet alone and insulin may be required. Class A - Discovered before pregnancy, controlled with diet alone, any duration or age of onset. Class B - Onset age 20 year or older, duration less than 10 years.
Class C - Onset age 10 -19 years, duration less than 10 -19 years. Class D - Onset age under 10 year, duration over 20 years, background retinopathy.
Class R - Proliferative retinopathy or vitreous hemorrhage.
Class F - Nephropathy with proteinuria over 500 mg/day.
Class RF - Criteria for both class R and F coexist.
Class H - Atherosclerotic heart disease clinically evident.
Class T - Prior renal transplantation.

Advantages of Priscilla White's Classification :
1.It separates patients in to groups according to age of onset, years of duration and presence or absence of micro or macrovascular change. 2.It provides a basis for comparison of many of pregnant diabetics in different institution.

Disadvantages :
•Number of groups are more and patients in same group may have different prognosis.
Thus it has a poor predictive value.

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