Economic Evaluation of The One-Step Scheme Compared With Two-Steps for Screening And Diagnosis of Gestational Diabetes In Colombia

ObjectiveGuidelines for screening and diagnosis of gestational diabetes mellitus (GDM) have been updated in the past several years, and various inconsistencies exist across these guidelines. Moreover, the quality of these updated guidelines has not been clarified. We thus conducted this systematic review to evaluate the relationship between the quality and detailed recommendations of these guidelines.Data sourcesThe Guidelines International Network Library, the National Institute for Health and Clinical Excellence (NICE) database, the Medline database, the Embase and the National Guidelines Clearinghouse were searched for guidelines containing recommendations on screening and diagnosis strategies for GDM between 2009 and November 2018.MethodsGuidelines included a target group of women with GDM, and contained recommendations for screening and diagnostic strategies for GDM were included in the present systematic review. Reviewers summarised recommendations on screening and diagnosis strategies from each guideline and rated the quality of guidelines by using the Appraisal of Guidelines Research and Evaluation (AGREE) criteria.ResultsA total of 459 citations were collected by the preliminary literature selection, and 16 guidelines that met the inclusion criteria were assessed. The inconsistencies of the guidelines mainly focus on the screening process (one step vs two step) and criteria of oral glucose tolerance test (OGTT) (International Association of Diabetes and Pregnancy Study Groups [IADPSG] vs CarpenterandCoustan). Guidelines with higher AGREE scores usually recommend a one-step OGTT strategy with IADPSG criteria between 24 and 28 gestational weeks, and the majority of these guidelines likely to select evidence by Grading of Recommendations Assessment, Development and Evaluation criteria.ConclusionsThe guidelines of WHO-2013, NICE-2015, American Diabetes Association-2018, Endocrine Society-2013, Society of Obstetricians and Gynaecologists of Canada-2016, International Federation of Gynecology and Obstetrics-2015, American College of Obstetricians and Gynecologists-2018, United States Preventive Services Task Force-2014 and IADPSG-2015 are strongly recommended in the present evaluation, according to the AGREE II criteria. Guidelines with higher quality tend to recommend a one-step 75 g OGTT strategy with IADPSG criteria between 24 and 28 gestational weeks.

Download Full-text

One step procedure for screening and diagnosis of gestational diabetes mellitus by diabetes in pregnancy study group of India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193563 ◽

2019 ◽

Vol 8 (8) ◽

pp. 3344

Author(s):

Dwarakanath L. ◽

Hema K. R. ◽

Hemashree P.

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Universal Screening ◽

Glucose Load ◽

Diabetes In Pregnancy ◽

Step Procedure ◽

One Step ◽

Screening And Diagnosis

Background: In the Indian context, screening for Diabetes is essential in all pregnant women, as the Indian women have an eleven-fold increased risk of developing glucose intolerance during pregnancy. For this, we need a simple procedure which is economical and feasible. Hence this study was undertaken as a screening as it is acceptable, economical and feasible to perform. Aim of this study was to assess the feasibility of one step procedure for screening and diagnosis of Gestational Diabetes Mellitus by Diabetes in Pregnancy Study Group of India (DIPSI).aim of the study was to study the occurrence of Gestational Diabetes mellitus, Tumkur, to assess the sensitivity and specificity of glucose challenge test, to assess the need for universal screening and to study the maternal and perinatal outcomes in patient with Gestational Diabetes Mellitus.Method: Type of study was prospective study. this study included 200 pregnant women attending the antenatal OPD in Sri Siddhartha Medical College, Tumkur. Data collection was in a predesigned proforma. Pregnant women with 24-28 weeks of gestation were given 75 grams of oral glucose load, irrespective of their meal and venous blood sample drawn after 2 hours. If blood glucose value was ≥140mg/dl, the screening was considered as DIPSI positive. These patients underwent OGTT.Results: Incidence of GDM was found to be 3.5% in the patients studied. 40% of cases did not have risk factors, hencethere is a need for universal screening. DIPSI was positive in 10 cases, of which 7 were OGTT positive. Patients were managed with diet and insulin. The maternal and perinatal outcome of pregnancy was good.Conclusion: For universal screening, DIPSI performed irrespective of last meal timing with 75g glucose load is a patient friendly approach. This method recommended by WHO serves both as a one-step screening and diagnostic procedure & is easy to perform besides being economical.

Download Full-text