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Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one-step and two-step methods

  1. SJ Meltzer1,
  2. J Snyder2,
  3. JR Penrod3,
  4. M Nudi1,
  5. L Morin4

Article first published online: 26 JAN 2010

DOI: 10.1111/j.1471-0528.2009.02475.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 117, Issue 4, pages 407–415, March 2010

Additional Information

How to Cite

Meltzer, S., Snyder, J., Penrod, J., Nudi, M. and Morin, L. (2010), Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one-step and two-step methods. BJOG: An International Journal of Obstetrics & Gynaecology, 117: 407–415. doi: 10.1111/j.1471-0528.2009.02475.x

Author Information

  1. 1

    Division of Endocrinology and Metabolism, Department of Medicine and Obstetrics and Gynecology, Faculty of Medicine, McGill University, Montreal, QC, Canada

  2. 2

    Department of Clinical Nutrition, McGill University Health Center, Montreal, QC, Canada

  3. 3

    Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada

  4. 4

    Department of Obstetrics and Gynecology, Faculty of Medicine, McGill University, Montreal, QC, Canada

*Dr SJ Meltzer, Division of Endocrinology and Metabolism, Royal Victoria Hospital, McGill University Health Center, 687 Pine Avenue West, M9, Montreal, QC, Canada, H3A 1A1. Email sara.meltzer@mcgill.ca

Publication History

  1. Issue published online: 8 FEB 2010
  2. Article first published online: 26 JAN 2010
  3. Accepted 25 November 2009. Published Online 26 January 2010.

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Keywords:

  • Cost analysis;
  • diagnosis;
  • direct/indirect costs;
  • gestational diabetes mellitus;
  • oral glucose tolerance test;
  • screening

Please cite this paper as: Meltzer S, Snyder J, Penrod J, Nudi M, Morin L. Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one-step and two-step methods. BJOG 2010;117:407–415.

Objective  To conduct a cost minimisation analysis of three methods of gestational diabetes mellitus (GDM) screening and diagnosis.

Design  Prospective randomised controlled trial.

Setting  University teaching hospital.

Population  Pregnant women (n = 1594) presenting for GDM screening.

Methods  Women presenting for GDM screening, who consented to participate, were randomised to GR1 [1-hour, 50-g glucose screen (GS) ± 3-hour, 100-g oral glucose tolerance test (OGTT)], GR2 (50-g GS ± 2-hour, 75-g OGTT) or GR3 (2-hour, 75-g OGTT). Demographics, health and time/travel cost information were assessed for each glucose testing visit.

Main outcome measures  Costs (direct and indirect) and prevalence of GDM diagnosis.

Results  The direct sampling costs of the glucose tests per woman were as follows: GS, CAN$12.57; 75-g OGTT, $36.10; 100-g OGTT, CAN$48.13. Among women in the two-step method groups diagnosed with GDM, 39% of the GR1 and 61% of the GR2 groups were diagnosed at the first step by GS ≥ 10.3 mmol/l, according to the Canadian Diabetes Association recommendations, contributing to a lower total cost in these groups. The total costs per woman screened were as follows: GR1, CAN$91.61; GR2, CAN$89.03; GR3, CAN$108.38. The GDM prevalence was similar (3.7%, 3.7% and 3.6%, respectively). The higher costs of GR3 were related to more blood draws and the time required for all women to undergo the 2-hour OGTT.

Conclusions  Careful consideration should be given to an internationally recommended method of universal screening for GDM which minimises the burden and cost for individual women and the healthcare system, yet provides diagnostic efficacy. The two-step method (GS ± OGTT) accomplished this better than the one-step method (75-g OGTT).

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