Diabetes guidelines could disadvantage thousands

Research from Cambridge University has raised concerns over the NICE guidelines for diabetes management in pregnancy.  The study, which was published this month in Diabetologia, highlights the small but significant difference in the diagnostic threshold between the fasting blood sugars recommended in the NICE guidelines (5.6 mmol per litre) and the WHO recommended level (5.1 mmol per litre).  The study monitored women who fell within this diagnostic “gap” giving birth at the Rosie Hospital in Cambridge between 2004 and 2008.  Their conclusions were that the WHO criteria identify women at substantial risk of complications who would not be identified by the NICE 2015 criteria.  These complications included increased rates of emergency Caesarean sections, excessive amniotic fluid and high birth weight babies.

Study author Dr Claire Meek from the Wellcome Trust-MRC Institute of Metabolic Science at the University of Cambridge, said “The international criteria are based on minimising the risk of harm to the mother and baby, whereas the NICE criteria have been based upon reducing costs to the NHS.”

But Prof Mark Baker, director of clinical practice at NICE, said “The expert NICE guideline development group undertook careful analysis with an economic model that showed the WHO 2013 criteria were not cost-effective; their criteria did not provide enough benefit in relation to the increased costs.  In addition, the WHO recommendation was weak and the WHO noted that their 2013 criteria may need rapid revision as economic data becomes available… We welcome new research in this important area and will keep the guideline under surveillance.”

Read the NICE guidelines here

The research abstract here

and a BBC report here