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Lower treatment targets for gestational diabetes: is lower really better?

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The rationale for management of gestational diabetes mellitus (GDM) is well established — treatment reduces the risk of macrosomia and its attendant complications. This Journal has carried the views of proponents of lower diagnostic and treatment targets for GDM in the context of updated Australian guidelines.1,2 In this article, we focus on the costly and potentially deleterious effects of suggested lower treatment targets. We argue that such targets are based on insufficient interventional data, create potential health and medicolegal risks and pose great problems for implementation, particularly to providers in regional and remote areas such as our own health district, which services an area about the size of Victoria. In our view, the disadvantages of lower treatment targets currently outweigh the limited evidence of benefits.

Evidence of risks and benefits to patients

Three key trials have informed current practice for managing GDM. The Australian Carbohydrate Intolerance Study (ACHOIS), an interventional study of 1000 women enrolled over about 10 years to 2003, used lower diagnostic thresholds as well as lower treatment targets.3 Treatment targets were blood sugar level (BSL) of 5.5 mmol/L (fasting) and 7.0 mmol/L (2 h postprandial) in the intervention group. These treatment targets are now…