miércoles, 7 de abril de 2010

Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis


Published 1 April 2010, doi:10.1136/bmj.c1395
Cite this as: BMJ 2010;340:c1395

Research
Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis

Karl Horvath, project manager EBM review center, head of outpatient facility diabetes and metabolism1,2, Klaus Koch, project manager3, Klaus Jeitler, scientific assistant1, Eva Matyas, scientific assistant1, Ralf Bender, head of department of medical biometry3, Hilda Bastian, head of department of health information3, Stefan Lange, deputy director3, Andrea Siebenhofer, professor for chronic care and health services research, project manager4,1

1 EBM Review Center, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria, 2 Division of Endocrinology and Nuclear Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 3 Institute for Quality and Efficiency in Health Care (IQWiG), Dillenburger Str. 27, 51105 Cologne, Germany , 4 Institute of General Practice, Goethe University, Frankfurt, Germany

Correspondence to: K Horvath Karl.Horvath@medunigraz.at

Abstract
Objective: To summarise the benefits and harms of treatments for women with gestational diabetes mellitus.
Design Systematic review and meta-analysis of randomised controlled trials.

Data sources: 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.

Review methods: Included studies were randomised controlled trials of specific treatment for gestational diabetes compared with usual care or "intensified" compared with "less intensified" specific treatment.

Results: 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, 95% confidence interval 0.21 to 0.75), and one randomised controlled trial reported a significant reduction of pre-eclampsia (2.5 v 5.5%, P=0.02). For the surrogate end point of large for gestational age infants, the odds ratio was 0.48 (0.38 to 0.62). 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, 0.14 to 0.70).

Conclusions: 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).

open here to see the full-text:
http://www.bmj.com/cgi/content/full/340/apr01_1/c1395

No hay comentarios:

Publicar un comentario