Implementation of new recommendations for the diagnosis of gestational diabetes (GDM): a five month audit

Background. Early diagnosis of GDM has an important role to prevent adverse outcomes. Recent international recommendations, according to the HAPO study and IADPSG Consensus Panel (Diabetes Care 2010;33:676), were implemented in our university hospital. After five months, we aimed to audit the impact and the appropriateness of use of the new diagnostic approach. Methods. Two five-month (June-October) periods, one before [2009, using the two OGTTs standard approach (S1)] and one after the implementation of the new criteria [2010, (S2)], were compared. Results. In the two periods, 256 (S1) and 245 (S2) pregnant women were examined. 298 OGTTs (50g, n=195; 100g, n=103) and 252 OGTTs (75g) were executed in S1 and S2, respectively. In S1, 54 (27.7%) 50gOGTTs resulted positive and 36 (66.7%) of those performed the 100gOGTT. In addition, 3 (1.5% of total) 50gOGTT negative women were submitted to 100gOGTT. 63 women did 100gOGTT only. In total, 14 (13.6%) 100gOGTTs were positive. In S2, 38 (15.1%) OGTTs resulted positive. In women who did the whole diagnostic evaluation in our hospital, 92.3% in S1 and 77.0% in S2 performed the correct protocol. The rate of incomplete OGTTs was low (0.7% in S1 and 2.4% in S2). Conclusions. Our data show that in our hospital new recommendations for GDM diagnosis are not correctly applied in about ¼ of cases. The main issue seems to be the lack of consideration of the new threshold of fasting glycemia (92 mg/dL) as main decisional driver for performing OGTT. Further education of ordering physicians is advisable.