Does intensive treatment of gestational diabetes have benefits?

January 01, 0001

Does intensive treatment of gestational diabetes have benefits?

These Austrian and German researchers endeavored to characterize the benefits and harms of treatments for women with gestational diabetes mellitus. They performed a systematic review and meta-analysis of randomised controlled trials using Embase, Medline, AMED, BIOSIS, CCMed, CDMS, CDSR, CENTRAL, CINAHL, DARE, HTA, NHS EED, Heclinet, SciSearch, several publishers’ databases, and reference lists of relevant secondary literature up to October 2009. They included randomized controlled trials of specific treatment versus usual care or more intensive versus less intensive control.

The researchers report: "Five randomised controlled trials matched the inclusion criteria for specific versus usual treatment. All studies used a two step approach with a 50 g glucose challenge test or screening for risk factors, or both, and a subsequent 75 g or 100 g oral glucose tolerance test. Meta-analyses did not show significant differences for most single end points judged to be of direct clinical importance. In women specifically treated for gestational diabetes, shoulder dystocia was significantly less common (odds ratio 0.40), and one randomised controlled trial reported a significant reduction of pre-eclampsia (2.5 v 5.5%). For the surrogate end point of large for gestational age infants, the odds ratio was 0.48. In the 13 randomised controlled trials of different intensities of specific treatments, meta- analysis showed a significant reduction of shoulder dystocia in women with more intensive treatment (0.31)."

The authors concluded: "Treatment for gestational diabetes, consisting of treatment to lower blood glucose concentration alone or with special obstetric care, seems to lower the risk for some perinatal complications. Decisions regarding treatment should take into account that the evidence of benefit is derived from trials for which women were selected with a two step strategy (glucose challenge test/screening for risk factors and oral glucose tolerance test)."

More intensive control of gestational diabetes results in less shoulder dystocias, but most other outcomes were not significantly different.

For the full abstract, click here.

BMJ 340:c1395, 1 April 2010
© Horvath et al 2010
Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. Karl Horvath, Klaus Koch, Klaus Jeitler, et al. Correspondence to K Horvath: [email protected]

Category: T. Endocrine/Metabolic/Nutritional, W. Pregnancy, Family Planning. Keywords: gestational diabetes, glycemic control, glucose challenge, shoulder dystocia, pre-eclampsia, systematic review with meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 27 April 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.