Zeck Willibald, Panzitt Thomas, Schlembach Dietmar, Lang Uwe, McIntyre David
Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, A-8036, Graz, Austria.
Croat Med J. 2007 Dec;48(6):831-41. doi: 10.3325/cmj.2007.6.831.
To compare Austrian and Australian national guidelines for gestational and pre-gestational diabetes and estimate the level to which physicians comply with their country's guidelines.
Austrian (ODG, Austrian Diabetes Society) and Australian guidelines (ADIPS, Australasian Diabetes in Pregnancy Society) for the treatment of gestational diabetes and pre-gestational diabetes were systematically reviewed. Current practices in two obstetric centers in Austria and Australia were assessed by interviewing key stakeholders through questionnaires assessing different components of diabetes care. For gestational diabetes, these components were screening, abnormal oral glucose tolerance test values (mmol/L), abnormal values for diagnosis, further management when abnormal values are detected, monitoring/glucose targets (mmol/L), further management and indications for insulin therapy, route and timing of delivery, and postpartum management and counseling. For pre-gestational diabetes, the components were management during the preconceptional period, glucose target values, medical surveillance, obstetric surveillance, medication used, route and timing of delivery, and postpartum management and counseling.
More variation was found in the management of gestational than pre-gestational diabetes. There were differences in oral glucose tolerance test and cut-off levels for diagnosing gestational diabetes in both centers and guidelines. Australian guidelines recommended two-stage screening for gestational diabetes, while Austrian guidelines recommended one-stage screening. At the Austrian obstetric center, amniocentesis was recommended for determining the start of insulin treatment in pregnant women with gestational diabetes. This approach was neither used at the Australian obstetric center nor recommended by any of the two guidelines.
Our study showed that it was difficult to standardize screening criteria and diagnostic methods for gestational and pre-gestational diabetes. National and international consensus has yet to be achieved in the management of diabetes in pregnancy.
比较奥地利和澳大利亚关于妊娠期及孕前糖尿病的国家指南，并评估医生对本国指南的遵循程度。
系统回顾了奥地利（奥地利糖尿病学会的ODG）和澳大利亚（澳大利亚妊娠糖尿病学会的ADIPS）关于妊娠期糖尿病和孕前糖尿病治疗的指南。通过问卷调查关键利益相关者，评估奥地利和澳大利亚两个产科中心在糖尿病护理不同方面的当前做法。对于妊娠期糖尿病，这些方面包括筛查、口服葡萄糖耐量试验异常值（mmol/L）、诊断异常值、检测到异常值时的进一步管理、监测/血糖目标（mmol/L）、胰岛素治疗的进一步管理和指征、分娩途径和时间，以及产后管理和咨询。对于孕前糖尿病，这些方面包括孕前管理、血糖目标值、医学监测、产科监测、使用的药物、分娩途径和时间，以及产后管理和咨询。
与孕前糖尿病相比，妊娠期糖尿病的管理差异更大。两个中心和指南在口服葡萄糖耐量试验及妊娠期糖尿病诊断的临界值方面存在差异。澳大利亚指南推荐对妊娠期糖尿病进行两阶段筛查，而奥地利指南推荐一阶段筛查。在奥地利产科中心，建议对患有妊娠期糖尿病的孕妇进行羊膜穿刺术以确定胰岛素治疗的开始时间。这种方法在澳大利亚产科中心既未使用，两个指南也均未推荐。
我们的研究表明，妊娠期和孕前糖尿病的筛查标准和诊断方法难以标准化。在妊娠糖尿病的管理方面，尚未达成国内和国际共识。
