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Consensus in Gestational Diabetes MELLITUS: Looking for the Holy Grail
Open AccessArticle

Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus

1
Oxford University Hospitals NHS Foundation Trust, Headington OX3 9DU, UK
2
Nuffield Department of Women’s Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
3
Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, UK
4
The Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Trust, Oxford OX3 7LE, UK
5
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2018, 7(10), 376; https://doi.org/10.3390/jcm7100376
Received: 22 August 2018 / Revised: 11 October 2018 / Accepted: 17 October 2018 / Published: 22 October 2018
(This article belongs to the Special Issue Therapeutic Strategies for Diabetes in Pregnancy)
Background: In response to concerns that the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria labeled too many women with gestational diabetes mellitus (GDM) without evidence of clinical or economic benefit, NICE recommended a change in diagnostic criteria in 2015. Aim: To compare diabetes associated maternal and neonatal complications in pregnancies complicated by GDM diagnosed using IADPSG criteria only, to those with GDM diagnosed using both IADPSG and NICE 2015 criteria. GDM screening was risk factor based. Methods: This was a secondary analysis of a trial of women with GDM diagnosed by the IADPSG criteria (fasting blood glucose (BG) ≥ 5.1 mmol/L, 1 h ≥ 10.0 mmol/L and 2 h ≥ 8.5 mmol/L). Outcomes were compared for two groups: NICE + IADPSG defined as those with GDM diagnosed by both the NICE 2015 and IADPSG criteria (fasting BG ≥ 5.6 mmol/L, 2 h ≥ 8.5 mmol/L); and IADPSG-ONLY (fasting BG 5.1 mmol/L to 5.5 mmol/L, and/or 1-hour ≥10.0 mmol/L, and 2 h ≥ 8.5 mmol/L). We were not able to obtain data for women with a 2-h value between BG 7.8–8.4 mmol/L (i.e., NICE-ONLY; NICE 2015 positive and IADPSG negative). All women were treated for GDM using targets of fasting BG < 5.3 mmol/L and 1-h post prandial BG < 7.8 mmol/L respectively. Results: Of 159 women, 65 (40.9%) were NICE + IADPSG and 94 (59.1%) IADPSG-ONLY. Hypoglycaemic medication use was similar in both groups: 52.3% NICE + IADPSG, 46.8% IADPSG-ONLY, OR 1.0 (0.5–1.9). The IADPSG-ONLY group delivered later than the NICE + IADPSG group; 39.0 weeks (sd 1.4) compared to 38.2 weeks (sd 2.5), p value 0.02. Fewer caesarean sections occurred in IADPSG-ONLY group 30.9% vs. 52.3%, OR 0.4 (0.2–0.9). Birthweight, large for gestational age, and other neonatal complications were not significantly different between groups. Conclusions: Gestational diabetes-associated perinatal complications were similar in both groups. The IADPSG criteria detect women with evidence of ongoing hyperglycaemia who may benefit from treatment during pregnancy. View Full-Text
Keywords: gestational diabetes mellitus; NICE 2015 guidelines; IADPSG guidelines gestational diabetes mellitus; NICE 2015 guidelines; IADPSG guidelines
MDPI and ACS Style

Bhatia, M.; Mackillop, L.H.; Bartlett, K.; Loerup, L.; Kenworthy, Y.; Levy, J.C.; Farmer, A.J.; Velardo, C.; Tarassenko, L.; Hirst, J.E. Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus. J. Clin. Med. 2018, 7, 376.

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