Abstract
BackgroundDespite many guidelines for the management of gestational diabetes available internationally, little work has been done to summarize and assess the content of existing guidelines. A paucity of analysis guidelines within in a unified system may be one explanatory factor. So this study aims to analyze and evaluate the contents of all available guidelines for the management of gestational diabetes.MethodRelevant clinical guidelines were collected through a search of relevant guideline websites and databases (PubMed, Web of Science, Embase, etc.). Fourteen guidelines were identified, and each guideline was assessed for quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Two independent reviewers extracted guideline recommendations using a “recommendation matrix” through which basic guideline information and consistency between search strategy and selection of evidence, between selected evidence and interpretation, and between interpretation and resulting recommendations were analyzed.ResultsFourteen documents were analyzed, and a total of 361 original recommendations for gestational diabetes mellitus (GDM) management were assessed. In all guidelines included, the recommendations were developed in five domains, namely, diagnosis of GDM, prenatal care, intrapartum care, neonatal care and postpartum care. Different guidelines appeared to have significant discrepancy in consistency of guideline content, but overall, there was consistency between search strategy and selection of evidence, between selected evidence and interpretation, and between interpretation and resulting recommendations (scilicet 49.31, 57.20 and 58.17%, respectively).ConclusionAlthough commonality in most recommendations existed, there were still some discrepancies between guidelines. Consistency of guidelines on the management of GDM in pregnancy is highly variable and needs to be improved.
Highlights
Despite many guidelines for the management of gestational diabetes available internationally, little work has been done to summarize and assess the content of existing guidelines
Information sources were identified from the National Institute for Health and Care Excellence (NICE), New Zealand Guidelines Group (NZGG), Scottish Intercollegiate Guidelines Network (SIGN), China Medlive, American Diabetes Association (ADA), Canadian Diabetes Association (CDA), International Diabetes Federation (IDF), PubMed, Web of Science, Embase, China National
1 We suggest that glyburide is a suitable alternative to insulin therapy for glycemic control in women with gestational diabetes who fail to achieve sufficient glycemic control after a 1-week trial of medical nutrition therapy and exercise except for those women with a diagnosis of gestational diabetes before 25 weeks gestation and for those women with fasting plasma glucose levels > 110 mg/dl (6.1 mmol/l), in which case insulin therapy is preferred; 2 We suggest that metformin therapy be used for glycemic control only for those women with gestational diabetes who do not have satisfactory glycemic control despite medical nutrition therapy and who refuse or cannot use insulin or glyburide and are not in the first trimester
Summary
Despite many guidelines for the management of gestational diabetes available internationally, little work has been done to summarize and assess the content of existing guidelines. This study aims to analyze and evaluate the contents of all available guidelines for the management of gestational diabetes. In mainland China and Hong Kong, based on international guidelines on pregnancy and diabetes mellitus, contextual guidelines for GDM management have been established through expert consensus [22, 23]. As the most authoritative form, CPGs have the potential to influence the care delivered by a large number of healthcare providers and the outcomes for patients, so it is universally acknowledged that the methodological quality of guidelines is very important and should be appraised [24, 25]. Our previous research found that, in general, the quality of GDM guidelines was relatively higher than that in the previous year [26], while the domains of Rigor of Development, Stakeholder Involvement and Editorial Independence of guidelines still needed to be improved
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