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Gestational Diabetes Screening and Treatment - Adult/Pediatric - Ambulatory [22]

Gestational Diabetes Screening and Treatment - Adult/Pediatric - Ambulatory [22] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols





Delegation Protocol Number: 22

Delegation Protocol Title:
Gestational Diabetes Screening and Treatment - Adult/Pediatric - Ambulatory
Delegation Protocol Applies To:
UW Health OB/Gyn Clinics and Family Medicine Clinics with OB/Gyn services

Target Patient Population:
Pregnant women receiving obstetric care at UW Health OB/Gyn and Family Medicine clinics
Delegation Protocol Champions:
Makeba Williams, MD - Department of Obstetrics and Gynecology
Jackie Gerhart, MD - Department of Family Medicine

Delegation Protocol Reviewers:
Jenny Accola, RN, BSN - Clinic Coordinator - UW OB/GYN
Linda Kiefer, RN - Clinical Supervisor – UW Health – Deforest-Windsor Clinic
Elizabeth Paape, RN - UW Health – Deforest-Windsor Clinic

Responsible Department:
Department of Obstetrics and Gynecology
Department of Family Medicine

Purpose Statement:
To delegate the authority from the patient’s OB/GYN or Family Medicine provider to Registered Nurses (RN), to
enter orders for glucose tolerance tests and make referrals to diabetes educators based on the results of those
tests.
Who May Carry Out This Delegation Protocol:
Registered Nurses (RN), trained in the use of this delegation protocol.

Guidelines for Implementation
Early Screening
1. Early screening will be performed at or around the time of the new OB nurse visit in all patients at high risk
for pre-existing diabetes. The RN will order a hemoglobin A1C in women at high risk for diabetes. Risk
factors for diabetes are:
1.1. BMI >30
1.2. BMI > 25 AND one other risk factor
1.2.1. History of gestational diabetes mellitus (GDM)
1.2.2. History of diabetes or glucose intolerance (A1c > 5.7% or fasting plasma glucose > 100 mg/dL)
1.2.3. Infant weight > 9 lbs
1.2.4. First degree relative with diabetes
1.2.5. High risk ethnicity (African American, Asian American, Hispanic/Latina, Asian Pacific Islander,
Native American, Eastern Indian)
1.2.6. History of polycystic ovary syndrome (PCOS) or glucose intolerance
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

1.2.7. Medial comorbidities: hypertension, hyperlipidemia, heart disease
1.2.8. History of unexplained stillbirth or unexplained malformed infant
2. Interpretation and follow-up of hemoglobin A1c results will be as follows:
2.1. < 5.8% = Normal:
2.1.1. Routine screen at 24 weeks
2.2. 5.9% - 6.4% = Prediabetes or early GDM:
2.2.1. Routine screen at 24 weeks
2.2.2. Consult to nutrition
2.2.3. Update past medical history with prediabetes
2.3. ≥ 6.5% = Pre-existing diabetes:
2.3.1. Consult to nutrition
2.3.2. Consult to diabetes education and management

Routine Screening
1. For all patients not previously diagnosed with diabetes, the RN will enter an order for 50 g 1 hour glucose
tolerance test (GTT) at 24 weeks.
2. Interpretation and follow-up
2.1. <140 mg/dL - no further action needed.
2.2. 140 - 199 mg/dL – additional testing needed.
2.2.1. The RN will order a diagnostic 100 gm, 3 hour GTT using OB Visit Smart Set
2.2.2. The RN will instruct the patient to fast for 8 hours prior to 3 hour GTT and provide patient with
education materials.
2.2.3. If two or more blood glucose values exceed the threshold value for that time interval, the RN
will order consults to nutrition and diabetes education per payer’s guidelines. See Table 1.
Blood Glucose Parameters

Table 1. Blood Glucose Parameters
Interval Blood Glucose (mg/dL)
Fasting 95
1 hour 180
2 hour 155
3 hour 140




3. 200 mg/dL or greater - indicates Gestational Diabetes Mellitus (GDM)
3.1. The RN will order consults to nutrition and diabetes education per payer’s guidelines.
3.2. The RN will order post-partum diabetes testing at 6 weeks post-partum.
3.3. The RN will place gestational diabetes in the patient’s past medical history.

Order Mode: Medications: Protocol/Policy, Without Cosign
Clinical Laboratory and Consult orders: Cosign Required, Protocol/Policy





References:
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

1. American College of Obstetricians and Gynecologists. Gestational diabetes mellitus. ACOG Practice Bulletin
No. 137. Obstet Gynecol 2013;122 Part 1:406-18
http://www.sweetsuccessexpress.com/uploads/Practice_Bulletin_No__137___Gestational_Diabetes_46.pdf
Accessed October 6, 2016

Collateral Documents/Tools:
UW Health Standards of Medical Care in Diabetes- Adult/Pediatric – Inpatient/Ambulatory –Clinical Practice
Guideline. February 2016

Approved By:
UW Health Ambulatory Protocol Committee: April 2013; *November 2016
UW Health Lab Practice Committee: April 2013; *November 2016
Clinical Knowledge Management Council: October 2013; *November 2016
UWHC Medical Board: November 2013; *November 2016
UW Health Chief Clinical Officer: November 2013; November 2016

Effective Date: December 2016

Scheduled for Review: December 2018
* expedited review process

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org