A study shows that being stricter in the diagnosis of gestational diabetes would save more than 30 million a year.
The study has been carried out by a group of endocrinologists from the San Carlos Clinical Hospital in Madrid and the Spanish Society of Endocrinology and Nutrition (SEEN), published in 'Diabetes Care'.
The research has followed the new criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) by which only a positive value of a single oral glucose overload between 24 and 28 weeks of pregnancy at the following levels are necessary: 92mg/dl on an empty stomach, 180 mg/dl at the time and 153 mg/dl at two hours of the oral glucose overload.
"The use of the new criteria of the IADPSG although it increases the prevalence of gestational diabetes from 10.6 percent to 35.5 percent, almost three more and a half times, a substantial improvement is obtained in all the variables studied, reducingHypertension induced by gestation in the mother, prematurity, caesarean section and instrumental deliveries, the need for admission to neonatological intensive care, fetal macrosomy and low weight newborns, being newborns with greater vitality, "heExplained the main author of the work, Alfonso L. Calle-Pascual.
It also continues, the implementation of these criteria implies substantial savings in the health cost using the same evaluation tools used by health managers, diagnostic related groups (GRDS).
"The cost is reduced by about 15,000 euros for every 100 screted women, which means more than 300,000 euros of savings in a year in our area. In this way, extrapolating the results to the Community of Madrid, an approximate savings ofMore than three million euros per year and if applied throughout Spain, it would be saving of more than 30 million euros, "he added.
In this sense, the also author of the work, Alejandra Durán, has reported that, to obtain these data, 1,750 pregnant women diagnosis of gestational diabetes were analyzed according to the classical criteria, between April 2011 and March 2012, and 1,526 pregnant women diagnosedaccording to the new criteria of the IADPSG, between April 2012 and March 2013.
Thus, experts verified that the second group had a decrease in the adverse effects of hyperglycemia, both in the mother and in the newborn, and that, in addition, the treatments were more cost-effective.In the same way, and with respect to the burden that would be for the services of endocrinology and nutrition the increase in the prevalence of gestational diabetes, they have assured that the new scenario could be supported using new forms of attention to this process.
"For example, the educator nurse, the group sessions with 8-10 patients simultaneously to instruct them in the necessary dietary modifications, determination of capillary blood glucose and the objectives of the control, telematic view and other forms of consultation as an alternative to theClassic face -to -to -face, it can mean an opportunity in this process, "they have apostilled.
Best health of the mother and the newborn
On the other hand, together with the increase in the prevalence of gestational diabetes, the use of the new diagnostic criteria of gestational diabetes supposes, according to the study carried out, the decrease of 24 percent of the cesarean rate and the reduction ofArterial hypertension by 14 percent more compared to the classic diagnostic criteria.
"This is something fundamental, taking into account that hypertension in pregnancy leads to preeclapsia and eclampsia that is a serious situation with significant weight gain, headache, nausea, vomitingand seizures, and which is an important motive for severe obstetric emergency, "Durán analyzed.
Regarding the newborn, it continues, there is a reduction in the prematurity of the newborn by 11 percent, a 20 percent reduction in the rate of macrosomic or large neonates for gestational age and a 24.5 percent decrease in 24.5 percent ofIncome in the neonatal intensive care unit, without this implying a low weight newborn, since they also decreased 6.5 percent.
"These results are of vital importance, since there is greater prematurity there is greater morbidity and mortality due to pulmonary immature and that respiratory pathology is the first cause of morbidity and mortality in newborns, although they also have cardiovascular, neurological, immunological pathology with greater risk of infections,etc., "he added.
As for the macrosomia, it is associated, as explained by Calle-Pascual, to a greater number of caesarean sections, as well as hemorrhages and complications in childbirth, while in the fetus it is related to greater mortality and to trauma, the mostShoulder dystocia frequent, and greater metabolic complications, such as hypoglycemia or hypocalcemia.
"In addition, in the long term the decrease of both macrosomic and low weight newborns can mean a reduction in the appearance of type II diabetes and obesity in adulthood and cardiovascular disease and postnatal type II diabetes in the mother," heDurán stressed.
Finally, 80 percent of pregnant women studied from both groups reached control objectives through dietary modifications and lifestyle, although in 20 percent of those who needed treatment there were differences in the type of insulin.
"While patients diagnosed with the classic criteria needed insulin in bowling, women diagnosed by the new criteria required greater treatment with basal insulin and basal/bolus to achieve objectives," has settled street-dascual.
