Expert consensus on gestational diabetes mellitus

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Diabetes &Metabolism 36 (2010) 511

Editorial

Expert consensus on gestational diabetes mellitus

A. Vambergue

Endocrinology and Diabetology Department, Hôpital Claude-Huriez, Rue Polonovski, CHRU, 59037 Lille cedex, France.

* Correspondence.

E-mail address: anne.vambergue@chru-lille.fr (A. Vambergue).

The impact of gestational diabetes on maternal and foetal health has been increasingly recognized. However, universal consensus on the diagnostic methods and thresholds has long been lacking. The recently published Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study has been used to confi rm the link between hyperglycaemia and maternal- foetal complications. Two randomized controlled trials of treatment for mild maternal hyperglycaemia were carried out successfully during the period of the HAPO study. In response to these studies, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) has proposed new guidelines for the screening and diagnosis of gestational diabetes mellitus. Given the fact that the potential economic impact of the IADPSG guidelines is unknown, and with minimal long-term data yet available on the offspring of the HAPO cohort, a true cost-effectiveness analysis will be diffi cult to accurately perform. Regardless, these guidelines serve to advance the discussion on the appropriate screening and diagnosis of diabetes in pregnancy.

In 1996, the Francophone Society of Diabetes (SFD) and the National Assembly of French Gynaecologists and Obstetricians (CNGOF) recommended universal screening of gestational diabetes based on a two-step strategy. In 2005, the French National Authority for Health (HAS) was not able to draw a conclusion as to the best strategy for screening and diagnosis.For the last three years a dedicated group of injection experts have analyzed the literature and have written a set of new recommendations. Their draft was discussed in detail at a meeting of 127 other injection professionals from

27 countries (the ‘TITAN’meeting; see other publication in this Supplement) and it went through several iterations both during and after that meeting. We have now arrived at a consensus document which is as robust as it can be given our current state of knowledge. The recommendations published here are thoroughly evidence-based. They stress the need for correct technique in every injection and show how critical this is for achieving optimal control of diabetes. We must start today, learning from these guidelines and translating them into clinical practice. Only in this way can our patients build the habits that will lead to better control and fewer complications in years to come. We recommend these new recommendations as widely as possible, knowing that they may still need some local adaption.

While the screening and diagnostic guidelines recommended by the IADPSG do not differ drastically from those already followed in much of Europe, it was necessary that they be discussed among French professional organizations to decide if they will be approved by the French practitioners.

The SFD and the CNGOF thus felt it was necessary to resubmit the question of gestational screening by looking at it from different angles and answering the following questions:

Who should be screened in France? When? Using which tests and diagnostic criteria? And what kind of care could be proposed in accordance with our clinical practice?

After an exhaustive review of the literature and an analysis of the IADPSG consensus, our two societies, the SFD and CNGOF, proposed an expert consensus on gestational diabetes mellitus for clinical practice in France.