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Stricter criteria for diagnosis and treatment of gestational diabetes is not beneficial
Clinical Question
Does the diagnosis and treatment of gestational diabetes based on lower glucose criteria benefit mothers or infants?
Bottom line
A lower diagnostic glycemic threshold for gestational diabetes of 92 mg/dL fasting or 153 mg/dL at 2 hours after a 75-g oral glucose challenge was not associated with a reduction in the rate of large-for-gestational-age infants. Diagnosis and treatment based on the stricter criteria doubled the proportion of patients diagnosed with gestational diabetes and was associated with increases in induction of labor, use of health services, use of pharmacologic agents, and neonatal hypoglycemia. Multiple other secondary outcomes for mothers and infants were not different. The lower criteria studied should not be implemented in practice. 1b
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Foundation
Setting: Outpatient (primary care)
Synopsis
This study was a randomized clinical trial conducted in New Zealand to evaluate the diagnosis and treatment of gestational diabetes based on lower glycemic thresholds as compared with usual care. Patients with diabetes mellitus, a history of gestational diabetes, and those with multiple gestation were ineligible. Participants (N = 4061) had a 75-g 2-hour glucose tolerance test at 24 to 32 weeks' gestation as part of their usual prenatal care. After informed consent, they were randomized to a lower diagnostic glycemic threshold for the diagnosis and treatment of gestational diabetes or to usual care. The stricter criteria were 92 mg/dL (vs 99 mg/dL) fasting or 153 mg/dL (vs 162 mg/dL) at 2 hours. The lower diagnostic threshold included the additional criterion of at least 180 mg/dL at 1 hour. The proportion of patients with a diagnosis of gestational diabetes was more than double in the stricter criteria group (310/2022 [15.3%] vs 124/2039 [6.1%]). The primary outcome of a large-for-gestational-age infant was not different between groups (8.8% vs 8.9%; NS). Newborn hypoglycemia occurred more frequently in the strict criteria group (10.7% vs 8.4%; adjusted relative risk [aRR] 1.27; 95% CI 1.05 - 1.54; number needed to treat to harm [NNTH] 44; 24 - 203). Multiple other neonatal outcomes showed no significant differences, including small-for-gestational-age, gestational age at birth, preterm birth, and the use of health services. Among mothers, there were associated increases in the strict criteria group for induction of labor (33.7% vs 30.2%; aRR 1.12; 1.02 - 1.22; NNTH = 28; 15 - 133), the use of pharmacologic treatment (10.9% vs 4.6%; aRR 2.40; 1.90 - 3.03; NNTH = 16; 13 - 21), and more frequent visits for care. Other maternal outcomes did not differ between groups.
Reviewer
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo
Toledo, OH
Comments
stricter criteria to diagnose Gestational diabetes is not be
Will not use the stricter criteria to diagnose Gestational diabetes.
Closer earlier management of Type 2 diabetes not advantageo
Good information