IN BRIEF The oral agents glyburide and metformin are both recommended by many professional societies for the treatment of gestational diabetes mellitus (GDM). Both therapeutic modalities have published safety and efficacy data, but there remains much debate among experts. Providers need a clear treatment plan for GDM based on a predictable level of clinical success in obtaining treatment goals. The proper selection of ideal candidates is paramount in achieving clinical success with the use of these medications in the treatment of GDM. This article presents clinical strategies for using oral agents in the management of GDM based on a pragmatic approach taken in a group of rural Native American women.

AIAN women have a higher risk for GDM and subsequently type 2 diabetes (T2D) than non-AIAN white females. We adapted a validated diabetes preconception counseling (PC) program for AIAN girls at high risk for GDM and their mothers. This paper presents preliminary baseline data, prior to the intervention, of both the girls and their mothers enrolled in an RCT to evaluate changes in GDM risk-reduction awareness, knowledge, health beliefs and behaviors after the Stopping GDM intervention. Data were collected using a dyadic model; both AIAN girls and their AIAN mothers (adult female caregiver) participated. These findings are on 27 mother (M) - daughter (D) dyads (n=54) from 2 of 4 sites (Southwestern U.S.). D (ages 12-24 years) were at risk for GDM as defined by BMI ≥85thpercentile or family history of T2D, and did not have diabetes (HbA1c < 6.5%). M’s mean (±SD) age was 41.3±14.1 years and 56% (n=15) had at least some college education; D’s mean age was 16.3±2.9 years and 89% were students. M and D completed online questionnaires separately on awareness, knowledge and health beliefs regarding GDM and reproductive health and healthy lifestyle. One open-ended question on awareness of GDM revealed that participants were unaware of GDM or the daughters’ risks. Mean pre-intervention knowledge scores were low for both M and D on diabetes prevention (M: 76.4+14.3, range=54-100%; D: 58.2+12.4, range=27-82%) and reproductive health and GDM knowledge (M: 67.2+11.2, range=46-85%; D: 35.0+18.3, range=0-62%). D had moderate levels of self-efficacy for healthy living (53.2±14.6) and pregnancy planning (86.4±22.6). Most Ds reported no communication with healthcare professionals (HCP) or their Ms regarding GDM or PC [(with HCP=15%; 8%, respectively), (with M= 15%; 4%,)]. Both AIAN mothers and daughters lacked awareness and knowledge of the girl’s risk for developing GDM. Developing culturally relevant PC programs could help decrease these risks. Disclosure D. Charron-Prochownik: None. S.M. Sereika: None. S.A. Stotz: None. A.F. Fischl: None. N. O'Banion: None. J. Powell: None. M.L. Aspaas: None. S. Goudeau: None. S.J. Thorkelson: None. S. Beirne: None. K.R. Moore: None. Funding National Institute of Nursing Research (1R01NR014831-01A1)

BackgroundNative American communities experience greater burden of diabetes than the general population, including high rates of Type 2 diabetes among women of childbearing age. Diabetes in pregnancy is associated with risks to both the mother and offspring, and glycemic control surrounding the pregnancy period is of vital importance.MethodsA retrospective chart review was conducted at a major Navajo Area Indian Health Service (IHS) hospital, tracking women with pre-existing diabetes who became pregnant between 2010 and 2012. Logistic regression was performed to find patient-level predictors of our desired primary outcome—having hemoglobin A1c (HbA1c) consistently < 8% within 2 years after pregnancy. Descriptive statistics were generated for other outcomes, including glycemic control and seeking timely IHS care.ResultsOne hundred twenty-two pregnancies and 114 individuals were identified in the dataset. Baseline HbA1c was the only covariate which predicted our primary outcome (OR = 1.821, 95% CI = 1.184–2.801). Examining glycemic control among pregnancies with complete HbA1c data (n = 59), 59% were controlled before, 85% during, and 34% after pregnancy. While nearly all women received care in the immediate postpartum period, only 49% of women visited a primary care provider and 71% had HbA1c testing in the 2 years after pregnancy.ConclusionsThis is the first analysis of outcomes among women with diabetes in pregnancy in Navajo Nation, the largest reservation and tribal health system in the United States. Our findings demonstrate the positive impact of specialized prenatal care in achieving glycemic control during pregnancy, while highlighting the challenges in maintaining glycemic control and continuity of healthcare after pregnancy.

Reference 1. Ho et al. Glycemic control and healthcare utilization following pregnancy among women with pre-existing diabetes in Navajo Nation. BMC Health Services Research (2018) 18:629.