So I will admit right now that I am a bit of a Geek*. Love, Love, Love to read. I have a favorite book of all time (Jane Eyre). A favorite modern fiction (The Time Travelers Wife). Favorite text books (tie Speroff and Gabbe). I have also have a favorite journal: the Journal of American Congress of Obstetrics and Gynecology (ACOG) which is fondly nick-named the “Green Journal” by OB/GYNs (because its green… hey we’re not the most creative bunch out there). ACOG sets the standard of care for OB/GYN in the United States, so when my Green Journal comes each month I always get a little excited, tearing off the plastic wrapper to see what new studies or recommendations have come out this month. I must admit though, these last several months I have been approaching the Green Journal with trepidation, for I fear change is a comin’ in the field of gestational diabetes and I know it will not be a easy transition.
One of the issues with studying gestational diabetes (GDM) is that there has been no global standard on how to diagnose it. Each country uses a different test to diagnose it, therefor studies done in one country could not be applied to patients in another. However, last year results from a huge study involving 25,000 women in 8 different countries was released that looked at GDM and had them all use the same diagnostic criteria: a fasting 2 hour 75 g glucose load, requiring 3 blood draws. The study was excellent and showed that by implementing this different diagnostic protocol, there was a significant reduction of bad outcomes such as preeclampsia, shoulder dystocia and neonatal admissions to the NICU. That was very exciting. But then when you read the fine print, it revealed that under these new criteria the number of people who would have the diagnosis of GDM would be doubled, approaching 17% . Ouch. I realized this was not going to make my patients happy: to make them all do a more annoying test and to tell twice as many of them that they have gestational diabetes.
When I read these statistics initially, my first thought was, “How can 17% of the population have gestational diabetes?” One of the biggest risk factors for gestational diabetes, though, is obesity. In American 30% of the population fall in the obese category with 1 in 10 Americans being diabetic or pre-diabetic. Since gestational diabetes is often a precursor to overt diabetes, perhaps these numbers are not so surprising after all. The good news in the study was that the majority of these patients were able to control their diabetes with diet and exercise instead of insulin, which is encouraging.
Currently several national organizations have endorsed the guidelines, however so far ACOG has remained silent. I’m pretty sure it just a matter of time until I open up a Green Journal and read a committee opinion that recommends changing to the new more stringent criteria. Though I will most likely hear some grumbling at first from both patients and staff, I think once implemented, the new criteria should help improve the health of both mother and baby. And that’s what matters most.
*This is perhaps a good quality for a doctor to have
Dr. Rupe
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