Validated guidelines for diagnosing gestational diabetes

A pregnant woman

Gestational diabetes can cause serious complications for mother and baby.  Early detection and management of the condition is key to preventing harm.  But what if our diagnostic tools are not up to scratch?

International Association of the Diabetes and Pregnancy Study Groups (IADPSG) Consensus Panel has recently issued an updated set of guidelines for diagnosing gestational diabetes.  A group of researchers tested them out  by applying them retrospectively to a cohort of 3953 pregnancies.

They found that these new guidelines would have diagnosed 2138 of these women with gestational diabetes, 112 more than the old method.

Appraisal hints

Users of this guidance should consider:

  • The extent to which the developers followed AGREE principles in the way they managed the development of the guideline
  • Whether the test-set of patients are similar to those in whom it would be used in real life.  The prevalence of gestational diabetes was much higher in this group than would be expected in real life, so we might expect this testing regimen to perform differently in real life.
  • Whether the guidance was validated against a gold standard of diagnosis, such as long term follow-up.
  • Whether this gold standard validation was conducted by people who were blinded to the diagnostic test results.
  • The criteria the test was being compared with.
  • Was the apparent increase in sensitivity accompanied by a decrease in specificity, i.e. would we expect more “false positives” from these diagnostic guidelines?
  • How many false negatives were found.

Reference

Lapolla A, Dalfrà MG et al.  New International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations for diagnosing gestational diabetes compared with former criteria: a retrospective study on pregnancy outcome. Diabetic Medicine 2011; 28 (9):1074–1077.

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Badenoch

Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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