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gestational diabetes mellitus (GDM)

Practice targeted AMC-style multiple-choice questions on gestational diabetes mellitus (GDM).

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middle-aged womanaboriginal and torres strait islander healthdiabetes mellitusendocrinologygeneral practicepregnancypreventative medicinerural healthwomen's health

A 32-year-old woman, currently 28 weeks pregnant, presents to the antenatal clinic for a routine check-up. She has a history of gestational diabetes mellitus (GDM) diagnosed at 24 weeks of gestation. Her current treatment includes dietary modifications and regular blood glucose monitoring. Her recent fasting blood glucose levels have been consistently between 5.5 and 6.0 mmol/L, and her postprandial levels are between 7.5 and 8.0 mmol/L. She reports feeling well and has no symptoms of hypoglycemia. Her obstetric history includes one previous pregnancy complicated by GDM, which was managed with insulin. Her current pregnancy is otherwise uncomplicated. What is the most appropriate next step in the management of her gestational diabetes?

A. Increase dietary carbohydrate intake
B. Start metformin therapy
C. Schedule an early induction of labor
D. Initiate insulin therapy
E. Continue current management and monitor closely
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An Aboriginal woman, 48 years old, attends your general practice for a routine health check. She has a history of gestational diabetes and lives in a rural community. When discussing preventative health screening, which of the following is the MOST culturally appropriate and evidence-based approach?

A. Refer her to a specialist diabetes clinic in a major city for comprehensive assessment and management, ensuring she understands the importance of specialist care.
B. Recommend genetic testing for diabetes risk, as Aboriginal Australians have a higher prevalence of certain genetic predispositions.
C. Offer a comprehensive assessment including HbA1c, urine albumin creatinine ratio, blood pressure, BMI, smoking and alcohol use, and discuss cardiovascular risk, while acknowledging the impact of social determinants of health and incorporating her preferences for health management.
D. Focus primarily on diabetes screening with HbA1c testing, as she has a history of gestational diabetes, and provide written information about diabetes management.
E. Advise her to follow a standard Western diet and exercise plan to manage her diabetes risk, as these are proven effective strategies.
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