Counterpoint: Establishing Consensus in the Diagnosis of GDM Following the HAPO Study

McIntyre, H. David; Metzger, Boyd E.; Coustan, Donald R.; Dyer, Alan R.; Hadden, David R.; Hod, Moshe; Lowe, Lynn P.; Oats, Jeremy; Persson, Bengt

doi:10.1007/s11892-014-0497-x

Cited by 36 publications

(20 citation statements)

References 34 publications

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“…The criteria used to diagnose gestational diabetes (GDM) have been the subject of much debate . Over 40 years ago, when the first criteria were developed, the diagnostic levels were based on the subsequent risk of the mother developing type 2 diabetes rather than on adverse perinatal outcomes .…”

Section: Introductionmentioning

confidence: 99%

Impact of the new IADPSG gestational diabetes diagnostic criteria on pregnancy outcomes in Western Australia

Laafira

White

Griffin

et al. 2015

Aust NZ J Obst Gynaeco

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Section: Introductionmentioning

confidence: 99%

Impact of the new IADPSG gestational diabetes diagnostic criteria on pregnancy outcomes in Western Australia

Laafira

White

Griffin

et al. 2015

Aust NZ J Obst Gynaeco

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“…There is an ongoing debate whether such an increase in prevalence allows identification of previously ignored risks, or results in overmedicalization of healthy pregnancies. 5 , 15 – 20 There is a need to closely look at arguments on both sides.…”

Section: Controversy: Should Iadpsg Criteria Be Adopted Universally?mentioning

confidence: 99%

“…This will lead to well-established benefits, in terms of immediate pregnancy outcomes, and likely benefits, in terms of future maternal and offspring health. 5 , 15 …”

Section: Controversy: Should Iadpsg Criteria Be Adopted Universally?mentioning

confidence: 99%

“…Experts favoring the IADPSG criteria argue that there is a high degree of congruence in the results of these two trials (ACHOIS and MFMU), 21 , 22 as discussed in detail here: Glycemic threshold at entry: Despite different diagnostic criteria of the two trials, as compared with the HAPO study, the subjects recruited in all studies had glycemic values comparable to those in the HAPO study. 5 , 12 , 15 , 21 , 22 In the ACHOIS study, the FPG value was used only to exclude women, initially using FPG 7.8 mmol/L (140 mg/dL) and changing it later to 7.0 mmol/L (126 mg/dL) after a change in the WHO recommendations. Thus, it would have been possible for women with marked fasting hyperglycemia to be included in this trial.…”

Section: Controversy: Should Iadpsg Criteria Be Adopted Universally?mentioning

confidence: 99%

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Updated guidelines on screening for gestational diabetes

Gupta

Kalra²,

Baruah³

et al. 2015

IJWH

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Gestational diabetes mellitus (GDM) is associated with an increased risk of complications for both mother and baby during pregnancy as well as in the postpartum period. Screening and identifying these high-risk women is important to improve short- and long-term maternal and fetal outcomes. However, there is a lack of international uniformity in the approach to the screening and diagnosis of GDM. The main purpose of this review is to provide an update on screening for GDM and overt diabetes during pregnancy, and discuss the controversies in this field. We take on debatable issues such as adoption of the new International association of diabetes and pregnancy study groups criteria instead of the Carpenter and Coustan criteria, one-step versus two-step screening, universal screening versus high-risk screening before 24 weeks of gestation for overt diabetes, and, finally, the role of HbA1c as a screening test of GDM. This discussion is followed by a review of recommendations by professional bodies. Certain clinical situations, in which a pragmatic approach is needed, are highlighted to provide a comprehensive overview of the subject.

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“…Recently, the International Association of Diabetes in Pregnancy Society Groups (IADPSG) established clinical decision limits for gestational diabetes [58] using the high-quality outcome data for the HAPO study [59]. However, even when good outcome studies are available, the selected arbitrary cut-offs selected are based on pragmatic considerations including what the consensus group negotiates to constitute a significant clinical risk along the continuum of risk [60].…”

Section: Post-analytical Quality and Clinical Outcomementioning

confidence: 99%

Performance criteria of the post-analytical phase

Sikaris¹

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Quality in healthcare is ideally at an optimal benchmark, but must be at least above the minimal standards for care. While laboratory quality is ideally judged in clinical terms, laboratory medicine has also used biological variations and state-of-the-art criteria when, as is often the case, clinical outcome studies or clinical consensus are not available. The post-analytical phase involves taking quality technical results and providing the means for clinical interpretation in the report. Reference intervals are commonly used as a basis for data interpretation; however, laboratories vary in the reference intervals they use, even when analysis is similar. Reference intervals may have greater clinical value if they are both optimised to account for physiological individuality, as well as if they are harmonised through professional consensus. Clinical decision limits are generally superior to reference intervals as a basis for interpretation because they address the specific clinical concern in any patient. As well as providing quality data and interpretation, the knowledge of laboratory experts can be used to provide targeted procedural knowledge in a patient report. Most profoundly critically abnormal results should to be acted upon to minimise the risk of mortality. The three steps in quality report interpretation, (i) describing the abnormal data, (ii) interpreting the clinical information within that data and (iii) providing knowledge for clinical follow-up, highlight that the quality of all laboratory testing is reflected in its impact on clinical management and improving patient outcomes.

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Counterpoint: Establishing Consensus in the Diagnosis of GDM Following the HAPO Study

Cited by 36 publications

References 34 publications

Impact of the new IADPSG gestational diabetes diagnostic criteria on pregnancy outcomes in Western Australia

Impact of the new IADPSG gestational diabetes diagnostic criteria on pregnancy outcomes in Western Australia

Updated guidelines on screening for gestational diabetes

Performance criteria of the post-analytical phase

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