“Urgent need” to revive the gestational diabetes standards of Australia: expert


A study An “urgent need” to encourage a review of the one-step diagnosis recommended by the University of Queensland’s International Association for Diabetes and Pregnancy Studies and to review diagnostic criteria for gestational diabetes (GDM) diagnosis. it called for the sex “IADPSG) and has been widely practiced in Australia.

Australia is currently going One-step diagnosis Patients received oral glucose tolerance test 75 g of fasting blood glucose level is measured at 2 hours eyes one hour after administration of the glucose solution. If any measurement of fasting blood glucose is present, the result is considered abnormal. When administered before or 1 hour, or 2 hours of results exceeding the specified threshold.

The two-step diagnostic criteria are recommended by Australian Diabetes Mellitus for Gestational Diabetes, which requires a non-hungry patient to take an hour of glucose measurement after ingesting 50 g of an oral glucose solution.

If the blood sugar level after one hour is more than 200mg / dL, no further inspection is not required, the diagnosis of GDM is done. If the blood concentration decreased to 130 mg / dL and 200 mg / dL, when patients received 3 hours glucose tolerance test fasting glucose tolerance measurements per hour more than once exceeds a specified threshold Is diagnosed with GDM.

The one-step criteria often have a higher rate of diagnosis compared to the two-step approach, but because people with hyperglycemia vary, the two-step approach has a lower rate of diagnosis. The author insisted. Whereas a risk factor for GDM, a one-step basis, since “women any of the measured values ​​of the three glucose measurement values ​​are slightly elevated” is diagnosed with GDM, erroneous detection in diagnosis occurs There is likely to be.

The Royal Australian College of General Practitioners (RACGP) opposed (pdf) With respect to the adoption of one-step process, claimed to evidence that identified by the one-step approach “subset of women” is considered normal by 2-step approach is insufficient, the intervention after diagnosis Increased monitoring.

A research team led by Jenny Doust of the University of Queensland 2021 study For women of the trial were randomly assigned to one-stage or two-stage GDM criteria, conducted by health Research Center of Hawaii to assert their case, 16.5 percent of women diagnosed in one-step group and 8.5 It is now treated in a two-stage group based on the diagnosis.

Since both are large, pregnancy infant, pre-eclampsia, hypertension, and but as had the same percentage of other risk factors for GDM, study, a big difference in clinical outcomes between the two groups I couldn’t find it.

“A significant proportion of the females assigned to the one-step arm of the trial went through a two-step process, which reflects the actual preferences of the females and clinicians who participated in the trial,” Doust said. A colleague writes.

The authors, when the proportion of women who are diagnosed spreads, confusion and of the lives of women who have been diagnosed, “the potential of more invasive form risk of birth of these women, to the infant by the restricted diet It can bring about the possibility of harm, such as harm. ” “Insulin use” supported by a study conducted at Kaiser Permanente Baldwin Park Medical Center in the United States

COVID-19 and later, in the Australian approach of two stages in order to prevent the community infection was introduced (pdf), A 2020 research This, led by the University of Queensland, has shown that it could reduce Australia’s overall diagnostic frequency by 25 percent.

Currently, trials aimed at comparing the two approaches are still underway, but the author concludes that “there is a significant risk of harm and significant burden to women and the healthcare system,” and diagnosed GDM in Australia. and asked for re-examination of the criteria. ..

Marina Chan

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Marina Chan is based in Melbourne, it focuses on Australian news. Contact her at [email protected]