Proposed criteria for gestational diabetes 'justified'

EASD 47th Annual Meeting

LISBON — New diagnostic criteria for gestational diabetes proposed by the International Association of the Diabetes and Pregnancy Study Groups may result in two to three times more pregnant women diagnosed and treated with gestational diabetes, based on measurements for determining blood glucose levels for the mother and unborn baby. During a session here, Peter Damm, MD, discussed the lack of consensus and overall controversy surrounding different diagnostic criteria for gestational diabetes used worldwide and questioned whether the proposed criteria are justified.

Historically, the lack of a clear, international consensus for gestational diabetes diagnostic criteria has made comparison of clinical outcomes and scientific studies difficult, according to Damm, head of the Center for Pregnant Women with Diabetes and professor in obstetrics at University of Copenhagen.

Peter Damm, MD

The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) called for new criteria that require a 75-g oral glucose tolerance test with venous plasma glucose measured at 0 (≥92 mg/dL), 1 (≥180 mg/dL) and 2 hours (≥153 mg/dL). The test is diagnostic for gestational diabetes if one value equals or exceeds one of the following values: 5.1 mmol/L at 0 hours; 10 mmol/L at 1 hour; or 8.5 mmol/L at 2 hours. The proposed criteria was based on a review of available evidence, including the large Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. Endocrine Today previously reported on the publication of the proposed criteria in Diabetes Care.

“It is nice that, in the end, we have criteria [for gestational diabetes] based on outcomes and not just statistics,” Damm said. “I hope these criteria will be approved by official bodies around the world so that we, after more than 40 years of gestational diabetes history, at last can get generally accepted diagnostic criteria.”

The proposed criteria have been approved by some organizations, such as the American Diabetes Association, and by some countries, including Germany, Italy and Japan. The WHO is expected to release a statement about the diagnostic criteria for gestational diabetes in late 2011 and the NIH is scheduled to hold a conference on the issue in fall 2012. However, the criteria have not been adopted by all. In a committee opinion published in the September issue of Women’s Health Care Physicians, a statement from the American College of Obstetricians and Gynecologists (ACOG) reads: “A universal recommendation for the ideal approach to screening and diagnosis of gestational diabete sremains elusive. At this time, the Committee on Obstetric Practice continues to recommend a two-step approach to screening and diagnosis.” – by Katie Kalvaitis

Disclosure: Dr. Damm was a member of the writing group of the International Association of Diabetes and Pregnancy Study Groups proposed criteria.

It is quite remarkable that of all of the areas of diabetes research, few have [caused] such confusion and controversy as gestational diabetes. What is equally remarkable is that after a veritable dearth of evidence, going back over decades, in the last 5 years or so we have had the publication of a number of major randomized trials and large observational studies that have impacted directly on this particular area; yet, for all that, the translation of these data into clinical practice is proving somewhat problematic.

– David R. McCance, MD

Metabolic Unit, Royal Victoria Hospital
Belfast, U.K.

Disclosure: Dr. McCance reports no relevant financial disclosures.

While the world is heatedly debating diagnostic guidelines for gestational diabetes, we should preoccupy ourselves by attempting to identify all women of child-bearing age with undiagnosed type 2 diabetes. First-trimester hyperglycemia is a potent teratogen, and our best weapon to fight is identification before conception. We should consider including a simple random blood glucose during the annual well-woman office visit, as many pregnancies are not planned.

– Kristin Castorino, DO

Internist and Clinical Research Physician
Sansum Diabetes Research Institute

Disclosure: Dr. Castorino reports no relevant financial disclosures.

For more information:

• Damm P. Controversies in gestational diabetes. The proposed IADPSG diagnostic criteria for gestational diabetes: Are they justified? Presented at: The European Association for the Study of Diabetes 47th Annual Meeting; Sept. 12-16, 2011; Lisbon.

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