Gestational diabetes — structured viva

Structured oral on gestational diabetes: why HAPO's continuous curve forces arbitrary thresholds, the ADIPS 2025 POGTT values, what treating GDM actually achieves (ACHOIS, Landon), metformin versus insulin with MiG and MiG TOFU numbers, and the postpartum contract — OGTT, lifelong surveillance, contraception and breastfeeding.

Prompt

The examiner opens: 'A colleague says we overdiagnose gestational diabetes and treat a number, not a disease. Defend the screening program.' The viva branches through the HAPO evidence, the diagnostic thresholds, treatment evidence, pharmacotherapy choices, and postpartum follow-up.

Stem

You are the GP. The challenge is about overdiagnosis. Your answer is about the shape of the risk curve and what treatment demonstrably prevents. ^[1]

References8Show

[1]Metzger BE, Lowe LP, Dyer AR et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med, 2008.PMID 18463375
[2]Crowther CA, Hiller JE, Moss JR et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med, 2005.PMID 15951574
[3]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
[4]Rowan JA, Hague WM, Gao W et al. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med, 2008.PMID 18463376
[5]Rowan JA, Rush EC, Plank LD et al. Metformin in gestational diabetes: the offspring follow-up (MiG TOFU): body composition and metabolic outcomes at 7-9 years of age. BMJ Open Diabetes Res Care, 2018.PMID 29682291
[6]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
[7]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
[8]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

Gestational diabetes — structured viva

Stem

You are the GP. The challenge is about overdiagnosis. Your answer is about the shape of the risk curve and what treatment demonstrably prevents. ^[1]

References8Show

[1]Metzger BE, Lowe LP, Dyer AR et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med, 2008.PMID 18463375
[2]Crowther CA, Hiller JE, Moss JR et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med, 2005.PMID 15951574
[3]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
[4]Rowan JA, Hague WM, Gao W et al. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med, 2008.PMID 18463376
[5]Rowan JA, Rush EC, Plank LD et al. Metformin in gestational diabetes: the offspring follow-up (MiG TOFU): body composition and metabolic outcomes at 7-9 years of age. BMJ Open Diabetes Res Care, 2018.PMID 29682291
[6]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
[7]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
[8]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