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Research Gaps in Gestational Diabetes Mellitus: Executive Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop

Wexler, Deborah J., MD, MSc; Powe, Camille E., MD; Barbour, Linda A., MD, MSPH; Buchanan, Thomas, MD; Coustan, Donald R., MD; Corcoy, Rosa, MD; Damm, Peter, MD, DMSc; Dunne, Fidelma, MD, PhD; Feig, Denice S., MD, FRCPC; Ferrara, Assiamira, MD, PhD; Harper, Lorie M., MD; Landon, Mark B., MD; Meltzer, Sara J., MD, FRCPC; Metzger, Boyd E., MD; Roeder, Hilary, MD; Rowan, Janet A., MD; Sacks, David A., MD; Simmons, David, FRACP, MD; Umans, Jason G., MD, PhD; Catalano, Patrick M., MD

doi: 10.1097/AOG.0000000000002726
Contents: Diabetes: Executive Summary

The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop on research gaps in gestational diabetes mellitus (GDM) with a focus on 1) early pregnancy diagnosis and treatment and 2) pharmacologic treatment strategies. This article summarizes the proceedings of the workshop. In early pregnancy, the appropriate diagnostic criteria for the diagnosis of GDM remain poorly defined, and an effect of early diagnosis and treatment on the risk of adverse outcomes has not been demonstrated. Despite many small randomized controlled trials of glucose-lowering medication treatment in GDM, our understanding of medication management of GDM is incomplete as evidenced by discrepancies among professional society treatment guidelines. The comparative effectiveness of insulin, metformin, and glyburide remains uncertain, particularly with respect to long-term outcomes. Additional topics in need of further research identified by workshop participants included phenotypic heterogeneity in GDM and novel and individualized treatment approaches. Further research on these topics is likely to improve our understanding of the pathophysiology and treatment of GDM to improve both short- and long-term outcomes for mothers and their children.

Numerous research gaps exist regarding early diagnosis of and pharmacologic treatment of gestational diabetes.

Diabetes Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; the Divisions of Endocrinology, Metabolism, and Diabetes and Maternal-Fetal Medicine, University of Colorado School of Medicine and Anschutz Medical Campus, Aurora, Colorado; the Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; Women & Infants Hospital of Rhode Island and Warren Alpert Medical School of Brown University, Providence, Rhode Island; the Diabetes Unit, Hospital de la Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Bellaterra, Barcelona, CIBER-BBN, Spain; the Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; College Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland; the Diabetes & Endocrine in Pregnancy Program, Mount Sinai Hospital and University of Toronto, Toronto, Canada; the Division of Research, Kaiser Permanente Northern California, Oakland, California; the Department of Maternal-Fetal Medicine, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama; the Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio; the Departments of Medicine and Obstetrics and Gynecology, McGill University Health Centre, Montreal, Quebec, Canada; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Kaiser Permanente Southern California, San Diego, California; National Women's Health, Auckland, New Zealand; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California; Campbelltown Hospital and Western Sydney University, Sydney, Australia; MedStar Health Research Institute, Hyattsville, Maryland; Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC; and the Center for Reproductive Health, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio.

Corresponding author: Deborah J. Wexler, MD, MSc, MGH Diabetes Center, 50 Staniford Street, Suite 301, Boston, MA 02114; email:

The conference was funded by National Institute of Diabetes and Digestive and Kidney Diseases. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health. Camille E. Powe is supported by career development awards from the NIDDK K23DK113218 and the Robert Wood Johnson Foundation's Harold Amos Medical Faculty Development Program (74256).

Financial Disclosure Dr. Damm has participated in a multinational study on the use of insulin in pregnancy in collaboration with Novo Nordisk. No personal honorarium was received. Dr. Feig led an investigator-initiated trial to which Apotex donated pharmaceuticals; Apotex has had no role in the design or interpretation of the study. Dr. Meltzer has worked as an advisory board consultant for Astra-Zeneca, Medtronic, Novo-Nordisk, and Sanofi within the last 3 years. The other authors did not report any potential conflicts of interest.

The authors thank the National Institute of Diabetes and Digestive and Kidney Diseases and the Eunice Kennedy Shriver National Institute of Child Health and Human Development for convening the workshop and Barbara Linder, Andrew Bremer, and Judith Fradkin for comments on earlier drafts of this manuscript. Deborah J. Wexler and Patrick M. Catalano were co-chairs and members of the planning committee. Camille E. Powe was a member of the planning committee.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received February 16, 2018. Received in revised form April 13, 2018. Accepted April 26, 2018.

Received February 16, 2018

Received in revised form April 13, 2018

Accepted April 26, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.