new diagnostic criteria for gdm & implications
TRANSCRIPT
New Diagnostic Criteria for GDM & Implications
Daniel LW Chan Department of Obstetrics & Gynaecology,
United Christian Hospital ([email protected])
22 May 2016
Annual Scientific Meeting of O&G Society of HK
Outline
• What has happened?
• What is happening?
• What will (may) happen?
What has happened?
N=148
EDUCATION & AWARENESS
HAPO New Engl J Med 2008
A continuum
IADPSG
Based on the HAPO study
aOR 1.5 aOR 1.75 aOR 2.0
Fasting 5.0 5.1 5.3
1-hour 9.3 10.0 10.6
2-hour 7.9 8.5 9.0
IADPSG consensus
aOR: adjusted Odds Ratio for selected adverse pregnancy outcome
No more “IGT”
>=1
>=2
>=2
>=1
• The GDG considered that the method proposed by IADPSG was appropriate & rather than further complicate the current situation by proposing another new set of criteria, it was advisable to adopt the same methodology for setting diagnostic cut-points
• Decided to accept the general principles behind how these new criteria were derived, in the interest of moving towards a universal standard recommendation for the diagnosis of GDM
Lower cut-off same as IADPSG consensus
No published cohort / intervention studies which compared the IADSPG criteria to the prev. WHO criteria
Cut-off
75g OGTT GDM DM in pregnancy
Fasting 5.1 - 6.9 >=7.0
1 hr >=10
2 hr 8.5 - 11.0 >=11.1
What is happening?
aOR 1.75 – 2.0 vs
aOR 2.0 vs
Retrospective Both groups untreated. No significant differences in maternal characteristics between GDM-1 & GDM-2
N=771 N=1121 N=7943
• A greater no. and proportion of adverse outcomes occurred among women at the higher end (aOR 2.0) of the IADPSG GDM glucose spectrum than at the lower end (aOR 1.75)
• Whether treating women in either / both groups would have resulted in a reduction in frequency of these outcomes is not known
• The use of aOR of 2.0 instead of 1.75 would reduce the % of GDM from 17.8% to 10.5%
WHO Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy 2013
McIntyre Best Pract Res Clin Obstet Gynaecol 2015
FIGO EAPM
• Glycemic dysregulation exists on a continuum, decision to pick a single binary threshold requires balancing the harms & benefits
• HAPO study, an observational study, was not designed to determine the benefits of intervention
• No available cost-effective analyses to examine the balance of achieved benefits vs increased costs
ADA rationale of re-introducing the old “2-step”
approach
• The lack of clinical trial interventions demonstrating the benefits of the “one-step” strategy (IADPSG)
• The potential –ve consequences of identifying a large new group of women with GDM
• Screening with a 50-g glucose load test does not require fasting & is therefore easier to accomplish
Meek Diabetologia 2015
Alternative strategies currently used
Booking / 1st T If negative, @ 24-28wk
China FPG >=5.6: GDM FPG >7.0: DM in pregnancy (all)
75g OGTT // FPG: 4.5 – 5.0: for OGTT; > 5.1: GDM
Indian subcontinent 75g OGTT - fasting / nonfasting 2hr value: 7.8-11.0: GDM (all)
Repeat
Latin America Same as China 75g OGTT – 2 hr: >7.8: GDM
UK 75g OGTT – 5.6 / 7.8: GDM (high risk group)
Repeat
What will happen?
Research
WHO Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy 2013
Number of publications “Gestational diabetes”
HAPO
IADPSG
WHO
FIGO
• HKCOG guideline
• HA COC working group
Summary
• What has happened? – HAPO -> IADPSG -> WHO -> FIGO
• What is happening? – Impact
• Increase prevalence
– Worldwide response • Increase in adoption of the IADPSG
• Yet, reservations exist
• What will (may) happen? – Research
– Discussion
New Diagnostic Criteria for GDM & Implications
Daniel LW Chan Department of Obstetrics & Gynaecology,
United Christian Hospital ([email protected])
22 May 2016
Annual Scientific Meeting of O&G Society of HK