title: Lower treatment targets for gestational diabetes: is lower really better?
abstract: Proposed lower diagnostic thresholds and lower treatment targets for gestational diabetes have been controversial internationally. Intervention trials for the recently revised lower Australian treatment targets are currently lacking. While there may be benefits, lowering treatment targets may cause a number of harms including increased risk of hypoglycaemia in pregnant women, greater medicolegal risk for health practitioners, and heavier economic costs for the health system. Regional and remote care providers in particular will have greater costs, and may be overwhelmed in attempts to implement new treatment targets. An excessively glucose-centric focus may divert attention and resources from identifying and addressing other important and growing contributors to adverse pregnancy outcomes, such as obesity. Important groups such as Aboriginal and Torres Strait Islander Australians may not gain overall benefit from lowering treatment targets for gestational diabetes because of current low birthweights and the effect of social costs. It has not yet been established whether implementing lower treatment targets for gestational diabetes will create more benefit than harm. Implementation at this stage is premature.
authors.affiliation: School of Public Health, Monash University, Melbourne, VIC, Australia. dev.kevat@monash.edu.
authors.forename: Dev A S
authors.initials: DA
authors.lastname: Kevat
authors.affiliation: Cairns Hospital and Cairns Diabetes Centre, Cairns, QLD, Australia.
authors.forename: Ashim K
authors.initials: AK
authors.lastname: Sinha
authors.affiliation: Cairns Hospital and Cairns Diabetes Centre, Cairns, QLD, Australia.
authors.forename: Anna G
authors.initials: AG
authors.lastname: McLean
mesh_terms: D000328:Adult; D001315:Australia; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002986:Clinical Trials as Topic; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis* / Q000191:economics / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D005320:Fetal Macrosomia / Q000517:prevention & control; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D009765:Obesity / Q000150:complications; D018579:Patient Selection; D011159:Population Surveillance; D011247:Pregnancy; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin