GP CCE Cases · pregnancy-and-reproductive-health
POGTT result at 27 weeks — CCE clinical encounter
CCE-style clinical encounter: a 33-year-old woman at 27 weeks has a positive POGTT (fasting 5.6, two-hour 9.8 mmol/L), is anxious about injecting insulin, sceptical about diet advice she has heard before, and plans to skip the six-week blood test because her last pregnancy's follow-up fell through. The candidate must diagnose GDM to ADIPS 2025 criteria, start lifestyle therapy with concrete instructions, pre-empt the metformin conversation, and lock in the postpartum plan.
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Prompt
A 33-year-old woman at 27 weeks' gestation returns for her POGTT result. Fasting glucose 5.6 mmol/L, one-hour 9.1 mmol/L, two-hour 9.8 mmol/L. Second pregnancy; first baby weighed 4.1 kg. BMI 29. She says her sister needed insulin injections and she wants nothing to do with needles. She never got around to the diabetes test after her first baby and does not see the point this time either.
Objectives
- Diagnose gestational diabetes using ADIPS 2025 thresholds and distinguish it from overt diabetes in pregnancy. [1]
- Start lifestyle therapy with specific, achievable instructions and self-monitoring targets.
- Explain the treatment ladder honestly — lifestyle, metformin, insulin — addressing her needle fear without promising she will avoid insulin. [3]
- Explain what treatment prevents, with numbers, given her previous macrosomic baby. [2]
- Lock in postpartum follow-up before she leaves: OGTT at 6–12 weeks with recall, breastfeeding support as diabetes prevention, contraception timing. [4][6]
References6ShowHide
- [1]Sweeting A, Hare MJ, de Jersey SJ et al. Australasian Diabetes in Pregnancy Society (ADIPS) 2025 consensus recommendations for the screening, diagnosis and classification of gestational diabetes. Med J Aust, 2025.PMID 40544364
- [2]Landon MB, Spong CY, Thom E et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med, 2009.PMID 19797280
- [3]Rowan JA, Hague WM, Gao W et al. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med, 2008.PMID 18463376
- [4]Bellamy L, Casas JP, Hingorani AD et al. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet, 2009.PMID 19465232
- [5]Aune D, Norat T, Romundstad P et al. Breastfeeding and the maternal risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Nutr Metab Cardiovasc Dis, 2014.PMID 24439841
- [6]Middleton P, Crowther CA Reminder systems for women with previous gestational diabetes mellitus to increase uptake of testing for type 2 diabetes or impaired glucose tolerance. Cochrane Database Syst Rev, 2014.PMID 24638998