The issue of screening for gestational diabetes has been reviewed by the
US Preventive Services Task Force which concluded that there was
insufficient evidence to recommend universal screening. One study
indicated that the number needed to screen to prevent one shoulder
girdle injury due to macrosomia (few of which would cause permamnt
neurolgic damage) was 10,000. The full report of the USPSTF is available
on the Web at http:\\text.nlm.nih.gov (look for Guide to Clinical
Preventive Services). The positive predictive value of a screening 1
hour glucose challenge in an average population (3% prevalence of GDM)
is only 20%.
(Please note new street address and phone #)
David Atkins, MD, MPH
Center for Practice and Technology Assessment
Agency for Health Care Policy and Research
6010 Executive Blvd, Suite 300
Rockville, MD
(301) 594-4016
-----Original Message-----
From: Jon Wilcox [mailto:[log in to unmask]]
Sent: Friday, September 18, 1998 5:00 AM
To: Ruth Swarbrick; [log in to unmask]
Subject: Re: Any suggestions?
Re: GDM Screening (from Ruth Swarbrick)
What about post polycose glucose prior to GTT?
This has been fairly standard here for decades; quite a number of false
positives though, despite the guidelines on utility of random glucoses -
I
had a patient with a post polycose glucose of around 12 last week with a
normal GTT - I had to "un-book" her from the Gestational Diabetic
Specialists' Clinic after the GTT result came back !
JW
Dr Jon Wilcox
General Medicine, Paediatrics and Obstetrics,
Glenfield Medical Centre,
452 Glenfield Road,
Auckland 1310, New Zealand
Phone or Fax +649-444-7656
e-mail [log in to unmask]
>I have just transferred to an idyllic country district general hospital
on
>rotation as part of my specialist registrar rotation in O and G and
have
>today sat, somewhat frustratedly through my first morbidity and
mortality
>meeting today. In this meeting it was suggested that we should be
screening
>everybody for gestational diabetes because if we wait for detection of
>macrosomic babies on scan "we have missed the boat". I was acutley
aware
>that what was needed was some discussion of positive and negative
predictive
>values of random glucose levels and GTT, and the benefits of
diagnosis(what
>are they?) but I lacked the skills to present a logical rebuttal. Can
anyone
>point me in the right direction?
>Many thanks,
>
>Ruth
>
>
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