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首页> 外文期刊>Journal of Clinical Medicine >Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus
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Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus

机译：NICE 2015年妊娠糖尿病标准的临床意义

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Background: In response to concerns that the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria labeled too many women with gestational diabetes mellitus (GDM) without evidence of clinical or economic benefit, NICE recommended a change in diagnostic criteria in 2015. Aim: To compare diabetes associated maternal and neonatal complications in pregnancies complicated by GDM diagnosed using IADPSG criteria only, to those with GDM diagnosed using both IADPSG and NICE 2015 criteria. GDM screening was risk factor based. Methods: This was a secondary analysis of a trial of women with GDM diagnosed by the IADPSG criteria (fasting blood glucose (BG) ≥ 5.1 mmol/L, 1 h ≥ 10.0 mmol/L and 2 h ≥ 8.5 mmol/L). Outcomes were compared for two groups: NICE + IADPSG defined as those with GDM diagnosed by both the NICE 2015 and IADPSG criteria (fasting BG ≥ 5.6 mmol/L, 2 h ≥ 8.5 mmol/L); and IADPSG-ONLY (fasting BG 5.1 mmol/L to 5.5 mmol/L, and/or 1-hour ≥10.0 mmol/L, and 2 h ≥ 8.5 mmol/L). We were not able to obtain data for women with a 2-h value between BG 7.8–8.4 mmol/L (i.e., NICE-ONLY; NICE 2015 positive and IADPSG negative). All women were treated for GDM using targets of fasting BG 5.3 mmol/L and 1-h post prandial BG 7.8 mmol/L respectively. Results: Of 159 women, 65 (40.9%) were NICE + IADPSG and 94 (59.1%) IADPSG-ONLY. Hypoglycaemic medication use was similar in both groups: 52.3% NICE + IADPSG, 46.8% IADPSG-ONLY, OR 1.0 (0.5–1.9). The IADPSG-ONLY group delivered later than the NICE + IADPSG group; 39.0 weeks (sd 1.4) compared to 38.2 weeks (sd 2.5), p value 0.02. Fewer caesarean sections occurred in IADPSG-ONLY group 30.9% vs. 52.3%, OR 0.4 (0.2–0.9). Birthweight, large for gestational age, and other neonatal complications were not significantly different between groups. Conclusions: Gestational diabetes-associated perinatal complications were similar in both groups. The IADPSG criteria detect women with evidence of ongoing hyperglycaemia who may benefit from treatment during pregnancy.
机译：背景：针对国际糖尿病协会研究小组（IADPSG）的标准将过多的妊娠糖尿病妇女（GDM）标记为无临床或经济效益证据的担忧，NICE建议在2015年更改诊断标准。 ：比较仅使用IADPSG标准诊断并合并GDM的妊娠合并糖尿病的孕妇和新生儿并发症，以及同时使用IADPSG和NICE 2015标准诊断并诊断为GDM的妊娠并发症。 GDM筛查基于危险因素。方法：这是对根据IADPSG标准（空腹血糖（BG）≥5.1 mmol / L，1 h≥10.0 mmol / L和2 h≥8.5 mmol / L）诊断为GDM的妇女进行的一项试验的二级分析。对两组的结果进行了比较：NICE + IADPSG定义为通过NICE 2015和IADPSG标准（空腹BG≥5.6 mmol / L，2 h≥8.5 mmol / L）诊断为GDM的患者;和IADPSG-ONLY（空腹血糖5.1 mmol / L至5.5 mmol / L，和/或1小时≥10.0mmol / L，2 h≥8.5 mmol / L）。我们无法获得2小时值在BG 7.8-8.4 mmol / L之间的妇女的数据（即，仅NICE; NICE 2015阳性，IADPSG阴性）。所有妇女均以禁食BG <5.3 mmol / L和餐后BG <7.8 mmol / L的目标治疗GDM。结果：在159名妇女中，只有65名（40.9％）为NICE + IADPSG，只有94名（59.1％）为IADPSG。两组的降血糖药物使用相似：NICE + IADPSG为52.3％，仅IADPSG为46.8％，或1.0（0.5-1.9）。 IADPSG-ONLY组晚于NICE + IADPSG组; 39.0周（sd 1.4），而38.2周（sd 2.5），p值0.02。仅IADPSG组中剖腹产的发生率为30.9％，而52.3％或0.4（0.2-0.9）。两组的出生体重，胎龄较大和其他新生儿并发症无明显差异。结论：妊娠糖尿病相关的围产期并发症在两组中相似。 IADPSG标准可检测出有持续性高血糖迹象的妇女，这些妇女可能会在怀孕期间从治疗中受益。

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