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

Abstract

Simmons et al. (1) have compared the National Institute for Health and Clinical Excellence (NICE), American Diabetes Association (ADA), and American College of Obstetricians and Gynecologists (ACOG) guidelines and conclude that the NICE guidelines reduce access to proven cost-effective management of gestational diabetes mellitus (GDM). Although the current NICE guidance represents a substantial increase in screening compared with previous NICE recommendations, the authors suggest that the guidelines remain too limited (2). The crucial questions are 1 ) how many women with GDM are missed by removing the age and tighter BMI criteria present in the ADA guidelines and 2 ) what are the additional costs of identifying these women? The NICE model found that the ADA criteria had borderline cost-effectiveness but could not undertake incremental cost analysis because of a lack of data …