title: Global adaptation of IADPSG recommendations: a national approach.
abstract: The current practice for diagnosing gestational diabetes mellitus (GDM) in Israel employs a two-step screening approach using a 50 g glucose challenge test (GCT) followed by a 3-hour 100 g oral glucose tolerance test (OGTT). The overall adherence to this process is more than 90%. Recently, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommended changing this practice to a single-step GDM screening, employing a 75 g OGTT. New plasma glucose cutoffs were recommended. To make recommendations for a new screening and diagnosis policy for GDM in Israel, a committee was assembled, including representatives of professional medical organizations, health maintenance organizations (HMOs), health policy makers, epidemiologists and biostatisticians. There was agreement that a consensus can be achieved only by clinical evidence and that consensus is a key factor for changing health policy. It was also realized that the availability of local data on the annual rates of GDM, its complications, and cost-effectiveness of screening and treatment are suboptimal. This generated two studies: the first provided additional analyses of data concerning Israeli women participating in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, and the second was a cost-effectiveness analysis based on Clalit Health Service's (the largest HMO in the country) database. We found that the prevalence of GDM in Israel is approximately 6% and is expected to increase to 9% by adopting the new IADPSG recommendations. The conclusion was that a one-step approach is presumed to be not only cost-effective but cost-saving, even under conservative estimates. We recommend such a process for other countries debating whether to change their GDM screening and diagnostic approach.
authors.affiliation: Community Medicine Division, Clalit Health Services, Israel. nickyli@clalit.org.il
authors.forename: Nicky
authors.initials: N
authors.lastname: Lieberman
authors.forename: Ofra
authors.initials: O
authors.lastname: Kalter-Leibovici
authors.forename: Moshe
authors.initials: M
authors.lastname: Hod
mesh_terms: D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D005260:Female; D005951:Glucose Tolerance Test / Q000191:economics; D006291:Health Policy / Q000191:economics; D006801:Humans; D006943:Hyperglycemia / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D007557:Israel / Q000453:epidemiology; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D015995:Prevalence