GEMS diabetes study NEJM 2022
If you think global GDM screening is a bit of a mess, you’re probably right. More added to the mix in with Carolyn Crowther's Lancet study from Auckland a couple of weeks ago
Gestational diabetes and pregnancy outcomes: GEMS Study. RCT of 4061 women. N Engl J Med 2022;387:587-98.
From the Intro:
The criteria recommended for the diagnosis of gestational diabetes in New Zealand were developed by the Australasian Diabetes in Pregnancy Society through a consensus process. After the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) cohort study, the International Association of Diabetes in Pregnancy Study Groups (IADPSG) recommended new diagnostic criteria — also developed through a consensus process — with a lower glycemic threshold for gestational diabetes. Professional organizations vary in their adoption of these lower glycemic criteria, with some in favor and others not or in favor of the new criteria but supporting additional criteria as well. Many organizations have suggested that further randomized trials are warranted to assess the effect of using lower glycemic criteria for the diagnosis of gestational diabetes.
Lower glycemic criteria for the diagnosis of gestational diabetes, would detect more women with milder disease than the diagnostic criteria with a higher glycemic threshold currently in use.
This study was conducted to assess whether the detection of gestational diabetes with the use of the lower glycemic criteria, with subsequent treatment, would lead to lower perinatal morbidity without higher maternal health-related risk than such detection and treatment with the higher glycemic criteria; an additional objective was to determine differences in the use of health services between the two trial groups.
Results:
63% of women in lower glycaemic criteria group would not have been identified as GDM by higher criteria and would not have received treatment.
Assignment to the lower glycaemic criteria led to:
2.5x more likely to be diagnosed/treated for GDM
No significant difference in incidence of LGA birth (NNT 4 for suspected LGA antenatally)
Similar risk of pre-eclampsia & mode of birth
Greater use of IOL (+12%)
Greater use of health services (diabetic specialists, dietician)
Greater likelihood of receiving drugs to lower glucose
Two other RCTs comparing IADPSG with higher glycaemic cut-offs have been done and show no improvement in perinatal health (refs in paper)
DT
