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Recommends contraception when pregnancy is not desired for individuals with diabetes who could become pregnant. Triggered by discussions about pregnancy planning, contraception needs, or when pregnancy is not desired.
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For a person with confirmed islet autoantibodies (early-stage type 1 diabetes), state the numerical progression risk to Stage 3 T1D by stage and age, set the age-stratified monitoring frequency (metabolic and HbA1c), apply the ≥10% longitudinal HbA1c rise → OGTT rule, and give the standard risk-modifier and communication framing. Use when a clinician asks how often should I monitor this Stage 1 child, what's the risk of this teenager progressing to insulin, adult with GAD positive what's the 5-year risk, my patient's HbA1c has risen 12% is that important, single autoantibody how often to retest, or how to counsel a family about progression risk. Grounded in Phillip et al. Diabetologia 2024 international staging and monitoring consensus, cross-referenced with Hussain et al 2026 IDF Europe roadmap.
Order and confirm islet autoantibody screening for early-stage type 1 diabetes — which antibodies to test (GAD65, IAA, IA2, ZnT8), sample types (capillary dried blood spot, venous), the mandatory two-sample two-method confirmation protocol, and how to interpret a positive, negative, or single-antibody result. Use when a clinician asks how to screen for early T1D, which islet autoantibodies to order, how to confirm a positive T1D antibody screen, is one autoantibody enough for T1D diagnosis, GAD antibody positive what next, or is running a general population or family-history T1D screening program. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
Classify a person with a positive islet autoantibody screen into a specific stage of type 1 diabetes (At Risk / Stage 1 / Stage 2a / Stage 2b / Stage 3a / Stage 3b / Stage 4) using the international consensus staging framework based on autoantibody count and glycaemic status. Use when a clinician asks how to stage a positive autoantibody screen, what stage of T1D is this, is this early-stage T1D, does this child need insulin yet, is this presymptomatic T1D, does this qualify for teplizumab, or presents a person with any combination of islet autoantibodies + glucose data. Applies across paediatric and adult populations. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
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| name | pdm-contraception-use |
| description | Recommends contraception when pregnancy is not desired for individuals with diabetes who could become pregnant. Triggered by discussions about pregnancy planning, contraception needs, or when pregnancy is not desired. |
Assess pregnancy intention, current contraceptive use, medical history (type of diabetes, comorbidities, medications, BMI, blood pressure), and reproductive goals. Document whether pregnancy is desired or not desired.
If pregnancy is desired → proceed to preconception care counseling; if pregnancy is not desired → proceed to contraception counseling.
Stratify contraceptive options using US Medical Eligibility Criteria (MEC) for women with diabetes:
| Condition | Typical MEC Category | Examples |
|---|---|---|
| No vascular complications | 1 (no restriction) or 2 (advantages > risks) | IUD, implant, progestin-only pill |
| Hypertension, nephropathy, or other vascular disease | 3 (risks > benefits) or 4 (unacceptable risk) for combined hormonal methods | Avoid estrogen-containing pills/patch/ring; prefer IUD, implant, progestin-only |
| Obesity (BMI ≥30) | 2 for most methods; monitor for VTE risk with estrogen-containing | Consider IUD, implant, progestin-only |
| Select method based on MEC category, efficacy, and patient preference. |
Initiate shared decision‑making to choose a contraceptive method aligned with MEC stratification and patient values; provide noncoercive counseling and prescribe or refer for the selected method.
A 30‑year‑old woman with type 2 diabetes, BMI 31, hypertension controlled on lisinopril, states she does not desire pregnancy for the next 2 years. After reviewing US MEC, a levonorgestrel IUD (category 2) is chosen. She receives counseling on insertion, benefits, and risks, and the IUD is placed during the visit.
Source: Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline, Endocrine Society/European Society of Endocrinology, 2025, https://doi.org/10.1210/clinem/dgaf288