The assessment for this module has been divided into 2 sections.• Mrs Begum is 38 years old, married with 3 daughters (she experienced gestational diabetes in all three pregnancies and required insulin therapy during the last pregnancy).

The assessment for this module has been divided into 2 sections.• Mrs Begum is 38 years old, married with 3 daughters (she experienced gestational diabetes in all three pregnancies and required insulin therapy during the last pregnancy).

The case study (1,000 words)
Written assignment (3,000 words)
Both sections must be submitted separately for marking and both sections must reach the pass standard in order to successfully complete the module. Please carefully read the marking criteria and the descriptors provided.

1. The Case study
The purpose of this assessment is to allow the student to apply theory to practice and is based around a case study. Please discuss the following case:

• Problems associated with diabetic retinopathy and pregnancy.

The Case
• Mrs Begum is 38 years old, married with 3 daughters (she experienced gestational diabetes in all three pregnancies and required insulin therapy during the last pregnancy). Following the birth of her last daughter (6 years ago) she was then found to have raised blood glucose levels and when an oral glucose tolerance test was performed diagnosed with type 2 diabetes mellitus.
• Her current medication is Lisinopril 20 mg, Simvastatin 40 mg, Metformin 500 mg twice daily. She does not always attend her appointments with the practice nurse and there has been some concerns regarding her concordance with medication.
• Her last retinal photography demonstrated background retinopathy. Microalbuminuria was found on one occasion, but further urine samples were not supplied by the patient.
• The last recorded HbA1c was 8.3% (67 mmol/mol), creatinine 90, total cholesterol 4, eGFR above 90. Last blood pressure recording 135/80. BMI 29.
• She attends the surgery complaining of vaginal thrush and in conversation says her husband wants her to have another baby. Mrs Begum has limited command of the English language, but fortunately the practice nurse can speak Mrs Begum’s native language.

Please add to the case study the critical appraisal of the following reference studies and add others as you see suitable.

Ref1. “Diabetes Control and Complications Trial (DCCT) 1993”

Ref2. “Maloney and Drury Am J Ophthalmol 1982”

Ref3. “Klein et al Diabetes Care 1990
”
Ref4. “Chew et al Diabetes Care 1995”

The case study should include the following sections:
• Introduction (very brief)
• Effect of pregnancy on retinopathy.
• Effect of retinopathy on pregnancy.
• What causes the deterioration in retinopathy?
• Management of retinopathy in pregnancy.
All according to a case study.

2. The Written Assignment
You are required to write a 3,000 assignment with the following options:
Option : Gestational Diabetes – a diagnosis not worth making?
Critically evaluate the screening strategies and treatment approaches you use at present. Identify an area you wish to change or update. Evidence-base your decided change and document how this change will be implemented. What will be the benefits to people with diabetes?

Please structure the Gestational Diabetes (GDM) assignment to include the following sections with brief discussion of each section:
1-Introduction

Explanation & Answer

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