Gestational Diabetes Mellitus: NICE for the U.S.?
A comparison of the American Diabetes Association and the American College of Obstetricians and Gynecologists guidelines with the U.K. National Institute for Health and Clinical Excellence guidelines
- David Simmons, FRCP, MD1,
- Aidan McElduff, PHD, FRACP2,
- Harold David McIntyre, FRACP3 and
- Mohamed Elrishi, MRCP4
- 1Institute of Metabolic Science, Cambridge University Hospitals, National Health Services Foundation Trust, Cambridge, England;
- 2Northern Sydney Endocrine Centre, St Leonards, New South Wales, Australia;
- 3University of Queensland and Mater Health Services, South Brisbane, Queensland, Australia;
- 4Department of Diabetes and Endocrinology, The Princess Alexandra Hospital, National Health Services Trust, Essex, U.K.
- Corresponding author: David Simmons, david.simmons{at}addenbrookes.nhs.uk.
Abstract
OBJECTIVE To compare recent U.S. and U.K. guidelines on gestational diabetes mellitus (GDM).
RESEARCH DESIGN AND METHODS The guidelines from the American Diabetes Association, the American College of Obstetricians and Gynecologists, and the National Institute for Health and Clinical Excellence (NICE) in the U.K. were collated and compared using a general inductive approach.
RESULTS There are substantial differences in the recommendations between the U.K. and the U.S. guidelines. Of particular note are the reduced sensitivities of the early and later antenatal and postnatal screening and diagnostic criteria. NICE undertook a cost-effectiveness analysis using lower prevalence estimates and limited outcomes and still showed screening for GDM to be cost-effective.
CONCLUSIONS The latest NICE recommendations appear to reduce access to proven, cost-effective management of GDM, an issue relevant in the current U.S. health care policy debate.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received July 28, 2009.
- Accepted October 5, 2009.
- © 2010 by the American Diabetes Association.
