Implementation of new recommendations for the diagnosis of gestational diabetes: a 5-month audit.
BACKGROUND
Recent international recommendations for the diagnosis of gestational diabetes (GD) were implemented in a university hospital. The aim was to audit the appropriateness of use of the new diagnostic approach.


METHODS
The same 5-month period, one before [2009, traditional two-step oral glucose tolerance test (OGTT) approach, S1] and one after the implementation of new criteria (2010, S2) were compared.


RESULTS
In the two periods, 256 (S1) and 245 (S2) pregnant women were examined and 298 (50 g, n = 195; 100 g, n = 103) and 252 (75 g) OGTTs were, respectively, executed. In S1, 54 (27.7% ) 50 g OGTTs resulted positive and 36 (66.7% ) of those performed the 100 g OGTT. In addition, three (1.5% of total) 50 g OGTT negative women were submitted to 100 g OGTT. Sixty-three women did 100 g OGTT only. In total, 14 (13.6% ) 100 g OGTTs were positive. In S2, 38 (15.1% ) 75 g OGTTs were positive. In women who did the complete protocol in the hospital, 98.3% in S1 and 77.0% in S2 performed the correct protocol (p < 0.0001).


CONCLUSIONS
In this hospital new recommendations for GD diagnosis are not correctly applied in 23% of cases. The main issue seems to be the lack of consideration of the new threshold for fasting glycemia (5.1 mmol/L) as a main decisional driver for performing OGTT.
Clinical Biochemistry Laboratory, Luigi Sacco University Hospital, and Department of Clinical Sciences, University of Milan, Milan, Italy. szoke.dominika@hsacco.it
Dominika
D
Szoke
Cristina
C
Valente
Alberto
A
Dolci
Mauro
M
Panteghini
D001786:Blood Glucose / Q000032:analysis*; D003133:Commission on Professional and Hospital Activities; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis*; D005260:Female; D018149:Glucose Intolerance / Q000097:blood / Q000175:diagnosis; D005951:Glucose Tolerance Test / Q000379:methods*; D006801:Humans; D011247:Pregnancy
D001786:Blood Glucose