NICE guidelines on gestational diabetes may reduce access to cost-effective strategies
April - 6 - 2010
Gestational diabetes (GDM) can cause complications before, during and after delivery. However, there are many different guidelines for screening and detection of GDM and the pros and cons of universal (based on blood tests) vs. selective (based on risk assessment) screening are still being debated. The recommendations from the American Diabetes Association, the American College of Obstetricians and Gynecologists and UK’s National Institute for Health and Clinical Excellence (NICE) were compared in a paper using a general inductive approach, with each guideline category treated as a theme. Significant differences were found among the guidelines of the 3 organizations in terms of screening, detection as well as perinatal management of GDM. The authors noted that although NICE based its screening recommendations on cost-effectiveness analysis, it may still have missed important cost-effective risk factors. In the detection of undiagnosed type 2 diabetes, the NICE guidelines had the tendency to delay testing and ignore important GDM criteria. In terms of postnatal testing, the NICE guidelines may lack sensitivity to identify postnatal diabetes and impaired glucose tolerance. The authors concluded that the NICE guidelines may restrict access to cost-effective GMD management strategies, findings which are relevant to the U.S. health care reform (Simmons, D.S. et al. Diabetes Care 2010, 33(1): 34).