Recommended changes to diagnostic criteria for gestational diabetes: Impact on workload

Background: Gestational diabetes mellitus (GDM) is recognised as a significant problem in pregnancy. Changes to GDM diagnostic criteria have been proposed following analysis of data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. We sought to assess the impact on the workload for GDM management in Australia that would occur if these changes were adopted. Aim: To assess the impact on health professional workload, specifically management of the number of additional women who would be diagnosed with GDM, should the newly recommended diagnostic criteria be adopted in Australia. Methods: We analysed oral glucose tolerance test results undertaken in pregnant women at two large pathology services in South West and Northern Sydney. We calculated GDM rates using current Australasian Diabetes in Pregnancy Society (ADIPS) Australian Criteria and the rates using the proposed new criteria. Results: These workload data compare ADIPS and proposed International Association of Diabetes and Pregnancy Study Groups Criteria. In a high-risk population examined in two time periods, the estimated increase in workload was 29.0% (based on November 2005 to August 2007 data) and 31.9% (based on September 2007 to August 2009 data). Data from Northern Sydney indicated a 21.7% increased workload (based on September 1998 to July 2009 data). Conclusions: If the newly recommended changes to the diagnostic criteria for GDM are implemented in Australia, we may need to change the way we currently structure our services to manage GDM, to cope with the workload impact of the significantly increased number of women who would require management. In some units this change will be substantial.