Controversies in management of diabetes from preconception to the postnatal period
A recent article published in the British Medical Journal (BMJ) is disputing the NICE guidelines established by the National Institute for Health and Clinical Excellence for women who are hyperglycemic during preconception to the postnatal period. NICE essentially states that screening for gestational diabetes should be by risk factor alone. The article acknowledges that NICE is aware that this approach has poor sensitivity and specificity compared with universal administration of the oral glucose tolerance test. However, in the guidelines that NICE expresses, this method misses nearly half of the women with gestational diabetes, particularly those with mild gestational diabetes.
The authors of the BMJ commentary note that the recommendation by NICE to offer delivery to all women with diabetes at 38 weeks gestation will represent a clinical practice change for many given the limited evidence for this approach. Rather, these authors suggest that optimizing glycemic control to prevent macrosomia and promoting the understanding by which diabetes increases the risk of stillbirth may be more prudent approaches in the long run.
The authors finally conclude that “The recommendations by NICE will be most helpful for clinicians managing predominately white women with type 1 diabetes who have a high use of the medical care system. Implementing the NICE recommendations in an area of obese, ethnically diverse populations with a high risk of type 2 and gestational diabetes will be far reaching and much more challenging.”
References
http://www.nelm.nhs.uk/Record%20Viewing/vR.aspx?id=591644
http://www.nice.org.uk/nicemedia/pdf/CG063Guidance.pdf
About the Author
Kathy Shattler received her Master of Science degree from Michigan State University in E. Lansing Michigan in Human Nutrition. Her twenty-two years of practice includes holding positions as a Lecturer, Chief Clinical Dietitian and Program Manager. Kathy is the Founder of Nutri-Care Consulting and is currently the Nutrition Director of www.CEU4U.COM, an online continuing education management company for Registered Dietitians and Dietetic Technicians.
