DOI: https://doi.org/10.1136/bmjopen-2018-023014
Introduction
Gestational Diabetes Mellitus (GDM) represents a significant health concern impacting both mothers and infants with both immediate and long-term health implications. Given the variance in the application of screening and diagnostic criteria, the systematic review “Evaluation of guidelines on the screening and diagnosis of gestational diabetes mellitus” published in BMJ Open delves into the quality and recommendations put forth in various international guidelines. The researchers from esteemed institutes, including Guangdong Pharmaceutical University and The Johns Hopkins School of Medicine, presented a comprehensive account of the current GDM screening landscape, highlighting disparities and aiming to steer towards a more homogeneous approach.
Methodology
This systematic review tapped into several reputed databases: the Guidelines International Network Library, National Institute for Health and Clinical Excellence (NICE), Medline, Embase, and the National Guidelines Clearinghouse, pooling data from 2009 to November 2018. The selection hinged on criteria focusing on recommended screening strategies and diagnostic procedures for GDM. The guidelines addressed should detail actionable measures, target GDM among women, and be relevant to clinical practitioners. In total, the preliminary search yielded 459 citations, out of which 16 guidelines aligned with the inclusion prerequisites were thoroughly assessed.
Discrepancies in Guidelines
The assessment revealed inconsistencies in the screening process—whether to employ a one-step versus two-step screening strategy—and the diagnostic criteria chosen—one advocating International Association of Diabetes and Pregnancy Study Groups (IADPSG) versus Carpenter and Coustan (C&C) criteria. The one-step 75g OGTT (oral glucose tolerance test) recommended by the majority of higher quality guidelines emphasizes diagnosing GDM between 24 and 28 gestational weeks.
Quality and Recommendations
According to the Appraisal of Guidelines Research and Evaluation (AGREE) criteria, it was discerned that guidelines of a higher quality are more inclined to advocate for a one-step 75g OGTT method applying the IADPSG criteria within the recommended gestational weeks. Renowned guidelines that stood out due to their substantive AGREE II scores included WHO-2013, NICE-2015, American Diabetes Association-2018, and several others. This robust endorsement builds upon the preference for a streamlined diagnosis that relies on a single-test method, potentially reducing patient inconvenience.
The Link Between Quality and Evidence Selection
It is noteworthy that the superior guidelines also tend to favor the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology when selecting evidence. GRADE aids in creating clear and actionable statements correlating evidence strength with recommendation strength, thereby contributing to the high AGREE scores observed.
Call to Action
This systematic review advocates for unifying GDM screening and diagnostic strategies internationally to combat inconsistencies and improve care quality. By embracing a single-step OGTT method and harmonizing around the IADPSG criteria, healthcare systems could advance towards standardized care maximizing positive outcomes for mothers and offspring.
Implications and Future Directions
The implications of this review extend beyond academia into clinical practices worldwide. There is a drive now more than ever to reach a consensus on the most effective screening methods, ensuring early and accurate GDM diagnosis. This change holds the potential to pivot the present state of maternal healthcare toward a more unified and comprehensive approach. Future research must assess the practical implementation of these guidelines and their impacts on GDM diagnosis rates and health outcomes.
Conclusion
The BMJ Open systematic review establishes a correlation between the quality of GDM screening guidelines and their methodological recommendations, providing clarity amidst diverse practices. This research plays a pivotal role in shaping future policies and standardizing care for GDM, aiming to secure optimal maternal and fetal health.
References
1. Zhu WW, Yang HX, Wei YM, et al. Evaluation of the value of fasting plasma glucose in the first prenatal visit to diagnose gestational diabetes mellitus in china. Diabetes Care 2013;36:586–90. DOI: (https://doi.org/10.2337/dc12-1157).
2. WHO Guidelines Approved by the Guidelines Review Committee. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva, 2013.
3. Clausen TD, Mathiesen ER, Hansen T, et al. Overweight and the metabolic syndrome in the adult offspring of women with diet-treated gestational diabetes mellitus or type 1 diabetes. J Clin Endocrinol Metab 2009;94:2464–70. DOI: (https://doi.org/10.1210/jc.2009-0305).
4. Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol 2018;131:e49–e64. DOI: (https://doi.org/10.1097/AOG.0000000000002501).
5. Moyer VA. Screening for gestational diabetes mellitus: U.S. preventive services task force recommendation statement. Ann Intern Med 2014;160:414-420. DOI: (https://doi.org/10.7326/M13-2905).
Keywords
1. Gestational Diabetes Mellitus screening
2. GDM diagnosis guidelines
3. One-step OGTT method
4. IADPSG criteria
5. AGREE criteria evaluation