Evaluation of guidelines on the screening and diagnosis of gestational diabetes mellitus: systematic review

Abstract

Objective: Guidelines for screening and diagnosis of gestational diabetes mellitus (GDM) have been updated in the past several years, and various inconsistencies exist across these guidelines. Moreover, the quality of these updated guidelines has not been clarified. We thus conducted this systematic review to evaluate the relationship between the quality and detailed recommendations of these guidelines.

Data sources: The Guidelines International Network Library, the National Institute for Health and Clinical Excellence (NICE) database, the Medline database, the Embase and the National Guidelines Clearinghouse were searched for guidelines containing recommendations on screening and diagnosis strategies for GDM between 2009 and November 2018.

Methods: Guidelines included a target group of women with GDM, and contained recommendations for screening and diagnostic strategies for GDM were included in the present systematic review. Reviewers summarised recommendations on screening and diagnosis strategies from each guideline and rated the quality of guidelines by using the Appraisal of Guidelines Research and Evaluation (AGREE) criteria.

Results: A total of 459 citations were collected by the preliminary literature selection, and 16 guidelines that met the inclusion criteria were assessed. The inconsistencies of the guidelines mainly focus on the screening process (one step vs two step) and criteria of oral glucose tolerance test (OGTT) (International Association of Diabetes and Pregnancy Study Groups [IADPSG] vs CarpenterandCoustan). Guidelines with higher AGREE scores usually recommend a one-step OGTT strategy with IADPSG criteria between 24 and 28 gestational weeks, and the majority of these guidelines likely to select evidence by Grading of Recommendations Assessment, Development and Evaluation criteria.

Conclusions: The guidelines of WHO-2013, NICE-2015, American Diabetes Association-2018, Endocrine Society-2013, Society of Obstetricians and Gynaecologists of Canada-2016, International Federation of Gynecology and Obstetrics-2015, American College of Obstetricians and Gynecologists-2018, United States Preventive Services Task Force-2014 and IADPSG-2015 are strongly recommended in the present evaluation, according to the AGREE II criteria. Guidelines with higher quality tend to recommend a one-step 75 g OGTT strategy with IADPSG criteria between 24 and 28 gestational weeks.

Keywords: appraisal of guidelines research and evaluation; diagnostic criteria; gestational diabetes mellitus; guidelines; screening strategies.

Figure 1

Flow diagram of the identification process for clinical practice guidelines and consensus statements on gestational diabetes mellitus (DM). GCP, good clinical practice.

Figure 2

Radar maps of the final domain scores for each guideline. Higher domain scores are mapped towards the periphery (closer to 100%), and lower domain scores are plotted towards the centre. The radar maps illustrate a visual gauge of the relative strengths and weaknesses of each guideline by domain, in comparison to the other plotted guidelines: (A) Worldwide guidelines, (B) North American guidelines, (C) European guidelines, and (D) Asia and Oceania. ACOG, American College of Obstetricians and Gynecologists; ADA, American Diabetes Association; ADIPS, Australasian Diabetes in Pregnancy Society; DDG, German Diabetes Association; EBCOG, European Board and College of Obstetrics and Gynecology; FIGO, International Federation of Gynecology and Obstetrics; HKCOG, Hong Kong College of Obstetricians and Gynaecologists; IADPSG, International Association of Diabetic Pregnancy Study Group; NICE, National Institute of for Health and Care Excellence; NIH, National Institutes of Health; SOGC, Society of Obstetricians and Gynaecologists of Canada; USPSTF, The United States Preventive Services Task Force.