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Diabetes education for women with gestational diabetes presents special challenges and opportunities. Factors to consider are the age of the patient, the short interval in which education and euglycemia must be achieved, and insurance issues. In addition, GDM may be the woman’s first abnormal medical diagnosis resulting in heightened emotions and feelings of overwhelm. My hope is that these “pearls” of wisdom will prove useful to you in your practice and prompt further discussion.

• Validate her feelings as a first step to building a trusting relationship. An abnormal diagnosis during pregnancy is doubly scary. Tears are normal, as is a bit of denial. Listen to her concerns and let her know you will help her through the process. Minimizing her fears in my experience creates distance and mistrust at a time when you need her to collaborate with you.
• Use technology whenever possible for communication. Your 80-year old T2DM patients may not have an interest in submitting their glucose log via electronic means but I guarantee the young pregnant patient does. Utilize patient portals to your EMR to improve compliance with submission of logs and for providing feedback. You both will benefit from this efficiency.
• Reinforce important information using several modes of communication. As an example, our program more than doubled compliance with post partum follow up (2HR OGTT 4-12 weeks post partum) by discussing reason for post partum follow up in person at MD consultation, then after delivery sending both an electronic reminder and letter to the patients home with lab orders reminding them to get the test done at or around their post partum visit.
• Support the patient unconditionally – even if their compliance is not ideal. A judgmental tone will shut down communication; support will increase it. Focus on the goal of a healthy pregnancy and baby. Identify barriers to compliance.
• Educate patients about filling medication and getting DM supplies at the pharmacy. This might be their first time hearing terms such as “formulary”, “Prior authorizations”, and co-pays. Help prevent uninformed patients from spending too much for meds if alternates are available.
• Help them see the bright side. Yes, a GDM diagnosis means that she has a 30-50% chance of developing T2DM in her lifetime but now she has that knowledge and can strategize with her doctor to prevent it. Yes, checking her blood sugar four times daily is no fun, but what better way to give herself feedback on the diet and medication changes she has put so much effort into implementing.

I welcome additions to this list of Pearls or questions.

Please forward questions or comments to swisch621@gmail.com.