There was a totally overlooked trial in @NEJM this week with jaw-dropping results. The question: how should we diagnose diabetes in pregnancy?
23,792 pregnant women randomized to receive either 1-step or 2-step screening for gestational diabetes.
nejm.org/doi/full/10.10…
/1
23,792 pregnant women randomized to receive either 1-step or 2-step screening for gestational diabetes.
nejm.org/doi/full/10.10…
/1
@NEJM There's no consensus on how to diagnose diabetes in pregnancy, which is VERY common and, if treated, can reduce risk of infant + maternal complications.
So the authors compared the more sensitive, single visit "one step" approach to a "two step" approach that can take 2 visits.
So the authors compared the more sensitive, single visit "one step" approach to a "two step" approach that can take 2 visits.
@NEJM There was a HUGE difference in diabetes diagnosis between the two groups:
One-step: 16.5% of women diagnosed with diabetes
Two-step: 8.5% diagnosed
This diagnosis comes with a lot of emotional and clinical baggage!!
…pregnancychildbirth.biomedcentral.com/articles/10.11…
One-step: 16.5% of women diagnosed with diabetes
Two-step: 8.5% diagnosed
This diagnosis comes with a lot of emotional and clinical baggage!!
…pregnancychildbirth.biomedcentral.com/articles/10.11…
@NEJM Was there a difference in outcomes between the two groups of women? 16.5% vs. 8.5%?
NOTHING
No difference in birth weight, pre-eclampsia, or C-section rates.
Oh, except babies in the one-step group were more likely to have hypoglycemia ... likely due to diabetes treatment
NOTHING
No difference in birth weight, pre-eclampsia, or C-section rates.
Oh, except babies in the one-step group were more likely to have hypoglycemia ... likely due to diabetes treatment
@NEJM I think this is a remarkable trial.
1) Demonstrates just how valuable RCTs are, especially for DIAGNOSIS, when you follow outcomes
2) Textbook example of how over-diagnosis happens and that over-diagnosis is REAL and HARMFUL
1) Demonstrates just how valuable RCTs are, especially for DIAGNOSIS, when you follow outcomes
2) Textbook example of how over-diagnosis happens and that over-diagnosis is REAL and HARMFUL
@NEJM Not measured: the enormous extra effort, $$ and stress suffered by women in the 2x diagnosis group
"Some women reported living in fear of risking the health of their baby and conducted extreme behaviours such as purging and starving themselves"
…pregnancychildbirth.biomedcentral.com/articles/10.11…
"Some women reported living in fear of risking the health of their baby and conducted extreme behaviours such as purging and starving themselves"
…pregnancychildbirth.biomedcentral.com/articles/10.11…
@NEJM Spread the word about this trial. Almost no one has tweeted about it and basically no media coverage.
nejm.org/doi/full/10.10…
nejm.org/doi/full/10.10…
@NEJM cc various folks who care about pregnancy + overdiagnosis @smilleralert @LaurawherryR @neel_shah @katybkoz @VPrasadMDMPH @ShannonBrownlee @RosenthalHealth
Important correction from @rayofdiana here:
https://twitter.com/rayofdiana/status/1370791382567190529
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