Behind the news - cutpoints for gestational diabetes diagnosis

Experts are divided on the need for lower cutpoints to diagnose gestational diabetes

THE Australian Diabetes in Pregnancy Society (ADIPS) is nearing completion of expert guidelines for diagnosing gestational diabetes (GDM), but disagreement among peak bodies has persisted.

The ADIPS’s new advice, which lowers the threshold for diagnosis, follows findings from a prospective international study called HAPO (Hyperglycaemia and Pregnancy Outcome).

One of the contentious issues is an expected doubling of GDM, with concerns about the capacity of the health system to cope.

Dr Alison Nankervis

President, Australian Diabetes in Pregnancy Society

“AT ROYAL Melbourne [Hospital] we’re looking at education in groups rather than one to one, so we are implementing that now.

“We’ve got that underway, managing the gestational diabetes in general obstetrics rather than specialist units, so we’re upskilling general obstetricians and we’re also looking at the possibility of managing through shared care programs.

“We’re having a cutpoint that picks up the majority of babies that are going to have adverse outcomes, whilst not being too unreasonable.

“Big babies are at risk of becoming overweight by five years of age and in their teens having abnormal glucose tolerance. 

There’s also evidence [of] a transgenerational effect.”

Clinical Associate Professor Wah Cheung,

President, Australian Diabetes Society

“WITH the new criteria... we will pick up a lot of extra women but we have no evidence that treating them is going to be beneficial, and the number that we will pick up will be substantial.

“If we’re going to diagnose more people we want to make sure it will be beneficial because it will be a lot more work and it will require more resources, plus you’re putting a lot more women through testing.

“We do not know whether treating [these extra women] is going to helpful.

“In the end until we have a randomised control trial that shows benefit of the new cut-offs, it’s always going to be contentious.

“It’s like this in a lot of medicine where you’ve just got to work out the best cost benefit and risk benefit of treatment.”