Case Study:
Mrs. Gomez & Gestational Diabetes

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Does Mrs. Gomez have

1. Hypertension?
2. Type 2 Diabetes?
3. History of Gestational Diabetes?

Mrs. Gomez is likely to have hypertension, and repeated high blood pressure readings would confirm this diagnosis. According to the recent Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommendations, normal blood pressure is <120/80, <130/80 mmhg.¹

Fast Facts The prevalence of type 2 diabetes in Mexican Americans over the age of 20 is about 10%.3 Type 2 diabetes is 2-3 times higher in Latinos than in non-Latino white or African American populations.4

Mrs. Gomez also has type 2 diabetes. She has a random glucose >200 mg/dL along with polyurea. Pre-diabetes has been defined as a fasting glucose between 100mg/dL and 126mg/dL or a two hour post glucose challenge between 140 mg/dL and 200 mg/dL.²

Given this patient's history of having two children weighing more than 9 pounds at birth, it is likely she had gestational diabetes during her pregnancy.

One could certainly order all tests needed for a full assessment, but initial tests should include Chemistry 18, percent A1C, urine analysis for proteinuria (spot morning urine for albumen and creatinine ratio), and a fasting lipid panel.

Fast Facts As a Latina, Mrs. Gomez's risk of developing type 2 diabetes after having gestational diabetes increases approximately 10% each year following her pregnancy.5

What do her lab results show?

Laboratory Values (Fasting)

• PG (random) 185 mg/dL
• A1C 9.2%
• LDL-C 158 mg/dL
• HDL-C 42 mg/dL
• TG 310 mg/dL
• Microalbumin 45 mg/g creatinine
• Normal creatinine and liver profile

Percent A1C - Level is elevated and is 2% above target.⁶

Fasting Plasma Glucose - Level is above normal (normal <100 mg/dL, type 2 diabetes ≥126 mg/dL)

HDL, LDL, and TG are all abnormal for type 2 diabetes.

• As is often seen in type 2 diabetes, her HDL and triglycerides are high. In addition, her LDL is significantly elevated, which is not typical for type 2 diabetes. All of these need to be addressed.

Fast Fact For every 1% that the A1C exceeds 7%, the risk of mortality over 10 years is 10% from cardiovascular causes and 17% from cerebrovascular causes.7

The patient has microalbumenuria, between 30 and 300 mg/g creatinine.

Given her A1C level, this patient has a 54% increased risk of mortality (20% cardiovascular and 34% cerebrovascular).

What additional testing would you recommend?

Additional testing would include⁸:

• annual dilated eye examination
• foot examinations every visit
• evaluation for neuropathy (i.e., monofilament testing)
• A1C levels every 3 months if not meeting goals or if treatment changes

What additional diagnoses can be made at this time?

Dyslipidemia
Obesity
Early retinopathy (microvascular disease)
Possible neuropathy

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