Читать книгу Gestational Diabetes - Группа авторов - Страница 66

Since its publication, multiple organizations, policymakers, and opinion leaders have adopted the IADPSG consensus including the WHO [74], FIGO [75], ADA [76], Endocrine Society [77], and many more local and national societies.

In 2011 [76], the ADA endorsed the IADPSG criteria, recognizing the possibility for increased prevalence and leaving some uncertainty on the benefits from the new diagnostic algorithm and the strength of the evidence for its implementation [78], and finally withdrew from its positive endorsement, stating: “There is insufficient data to strongly demonstrate the superiority of one strategy over the other” [79, 80].

The National Institutes of Health in a 2013 consensus suggested that the single-step 75 g offers some advantage, mainly the ability to diagnose GDM within a day, whereas the 2-step 100 g approach is not used outside of pregnancy and is preformed primarily in the United States and therefore there would be value in a consistent diagnostic standard across the world, during and prior/after pregnancy. However, the single-step approach, as proposed by the IADPSG, is anticipated to increase the frequency of GDM, with a great impact on medical resources, without clear advantage to treatment. Consequently, the National Institute of Health panel has concluded that: “…there is not sufficient evidence to adopt a one-step approach, such as that proposed by the IADPSG…the panel recommends that the two-step approach be continued” [81].

ACOG also release a committee opinion [82] and recently an updated practice guideline [83] supporting the traditional approach for GDM, although recognizing the possibility that: “individual practices and institutions may choose to use the IADPSG’s recommendation, if appropriate, for the population they serve.”

The principal reason for maintaining the recommendation, not adopting the IADPSG criteria, is the lack of evidence that treatment according to the IADPSG criteria will improve outcome and the available evidence base for treatment by the current guidelines.