Recent trials comparing definitions of gestational diabetes: a need to step back

Abstract

BackgroundIn 2013, the Australian Diabetes In Pregnancy Society (ADIPS) recommended an expanded definition for gestational diabetes (GDM). The RACGP, among other representative groups, questioned the evidence for change and continues to recommend the previous 2-step testing process using higher glucose cut-offs. ObjectiveThe changed definition has doubled the proportion of women diagnosed with GDM in Australia, despite Australian non-randomized studies showing no improvement in outcomes.We examined four recent large randomised trials – in the USA, New Zealand, and Iran - which evaluated the impact of GDM definitions on patient-relevant outcomes. All studies found increased numbers of women diagnosed but none found improvement in perinatal or maternal outcomes.DiscussionGiven these trials’ results showing no improvement in outcomes but increased treatment, costs, concerns, and inconvenience to women, the RACGP and others should review the diagnosis of gestational diabetes. Meanwhile general practitioners should continue to offer women the 2-step process.