NICE challenge on postnatal reclassification of glucose tolerance in women previously diagnosed with gestational diabetes mellitus

Abstract

AbstractWomen with a history of gestational diabetes mellitus (GDM) are at increased risk of developing diabetes. National Institute for Health and Clinical Excellence guidelines (July 2008) recommend the use of fasting plasma glucose (FPG) but not an oral glucose tolerance test (OGTT) at the six‐week postnatal check. Our data analysis aims to challenge this recommendation.Retrospective data were obtained for 95 women with GDM who delivered at Queen Mary's Hospital, Sidcup, UK (2003–2008). The results of the FPG concentration were assessed in relation to the two‐hour glucose value.Of the 95 OGTTs, the two‐hour glucose value revealed that seven had diabetes and 19 had impaired glucose tolerance (IGT). However, 12 women had IGT and one had diabetes with a normal FPG (<6.0mmol/L). The sensitivity and specificity of using FPG for the diagnosis of postnatal diabetes are 85.7% and 87.5%, respectively.In our population, using a six‐week postnatal FPG is unsatisfactory for evaluating the glucose tolerance of women with previous GDM as it would result in failure to diagnose 63.2% of those with IGT and a smaller proportion of those with diabetes. It is established that lifestyle changes can reduce the incidence of diabetes in individuals with IGT. For this reason, the OGTT remains the preferred option for the postnatal follow up of women with previous GDM in our hospital. Copyright © 2010 John Wiley & Sons.