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SCREENING AND DIAGNOSIS ARTICLES
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Diabetes Screening Reminder for Women With Prior Gestational Diabetes – A Randomized Controlled Trial

Chloe A. Zera, MD, MPH, David W. Bates, MD, MSc, Alison M. Stuebe, MD, MSc, Jeffrey L. Echer, MD, and Ellen W. Seely, MD (Obstet Gynecol 2015;0,0)

OBJECTIVE: To evaluate whether an electronic health record (EHR) reminder improves rates of screening for type 2 diabetes in women with prior gestational diabetes.

METHODS: We randomly allocated primary care providers (by clinic site) to a reminder for type 2 diabetes screening within the EHR or to usual care. Women with previous gestational diabetes mellitus were identified through an automated search of  laboratory results and the problem list. We compared rates of screening during the study period (2010–2012) in women at intervention sites with those at control sites. With a sample size of 850 participants, we had 80% power to detect a 15% difference in screening rates.

RESULTS: We included 847 individuals seen at a participating clinic during the study period, of whom 471 were at a reminder clinic and 376 were at a control clinic. A similar proportion of women were screened for type 2 diabetes in both groups (n5265, 56.3% of the reminder group compared with n5206, 54.8% of the control group, P5.67; adjusted odds ratio [OR] 1.04, 95% confidence interval [CI] 0.79–1.38). Patient characteristics associated with risk for diabetes including body mass index (adjusted OR per kg/m2 1.05, 95% CI 1.01–1.08) and race (adjusted OR for nonwhite race 2.14, 95% CI 1.57–2.92) were significantly associated with screening.

CONCLUSION: A simple EHR reminder did not increase the rate of diabetes screening in women with prior gestational diabetes mellitus.

 

Perspectives on the Proposed Gestational Diabetes Mellitus Diagnostic Criteria

Oded Langer, MD, PhD, Jason G. Umans, MD, PhD, and Menachem Miodovnik, MD (Obstet Gynecol 2013;0:1–6)

To date, The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria or the diagnosis of gestational diabetes mellitus (GDM) have not been analyzed systematically for medical, social, and economic ramifications if used in substitution for the current GDM diagnostic criteria. The IADPSG dependence on expert opinion and consensus rather than on rigorously obtained outcome measures is concerning given the dramatic changes in clinical intervention and medical-resource reallocation that would follow their wide adoption. This commentary attempts to highlight needed research as well as the key knowledge gaps that should prevent adoption of the revised criteria until their effect on perinatal outcomes and health care costs is determined.

 

Screening and Diagnosis of Gestational Diabetes Mellitus - A Critical Appraisal of the New International Association of Diabetes in Pregnancy Study Group recommendations on a national level.  

Ofra Kalter-Leibovici, MD; Laurence S. Freedman, PhD; Liraz Olmer, MA; Nicky Liebermann, MD; Anthony Heymann, MD; Orna Tal, MD; Liat Lerner-Geva, PhD; Nir Melamed, MD; Moshe Hod, MD. Diabetes Care 35:1894-1896, 2012

OBJECTIVE- To study the implications of implementing the International Association of Diabetes in Pregnancy Study Group (IADPSG) recommendations for screening and diagnosis of gestational diabetes mellitus (GDM) in Israel and explore alternative methods for identifying women at risk for adverse pregnancy outcomes.

RESEARCH DESIGN AND METHODS-We analyzed data of the Israeli Hyperglycemia and Adverse Pregnancy Outcomes study participants (N=3,345). Adverse outcome rates were calculated and compared for women who were positive according to 1) IADPSG criteria, 2) IADPSG criteria with risk stratification, or 3) screening with BMI or fasting plasma glucose (FPG).

RESULTS-Adopting IADPSG recommendations would increase GDM diagnosis by ≈50%.  One-third of IADPSG-positive women were at low risk for adverse outcomes and could be managed less intensively.  FPG ≥ 89 mg/dl or BMI ≥ 33.5 kg/m2 at 28-32 weeks of gestation detected proportions of adverse outcomes similar to IADPSG criteria.

CONCLUSIONS-Implementing IADPSG recommendations will substantially increase GDM diagnosis.  Risk stratification in IADPSG-positive women may reduce over-treatment.  Screening with FPG or BMI may be a practical alternative.