2 NEWS
2 NEWS
7 SEPTEMBER 2018 australiandoctor . com . au
GDM : big change , for little benefit ?
Antony Scholefield THE move to a lower threshold for the diagnosis of gestational diabetes mellitus ( GDM ) has pushed up costs without improving outcomes for mothers or babies , a study suggests .
The Australasian Diabetes in Pregnancy Society ( ADIPS ) endorsed the fasting plasma glucose cut-off of 5.1mmol / L in 2014 , based on international research . But the change has been controversial , with the RACGP arguing it should be 5.5mmol / L .
Unpublished research presented at the ADIPS annual scientific meeting in Adelaide last month showed the new threshold had led to a cost blow-out of more than half a million dollars a year at one Melbourne hospital .
This was based on the diagnosis of GDM in 329 women who would not have been diagnosed under the previous guidelines .
Except for a small reduction in the rate of very large babies , the study did not identify any improved outcomes .
But the author , Melbourne obstetrician Dr Tom Cade , said the thresholds were based on robust evidence and the issue might be better
Lowering the threshold has led to cost blow-outs .
addressed by reviewing the management of women who only slightly exceeded the cut-off .
“ The higher costs are essentially because GDM puts women in the high-risk model of care ,” he told Australian Doctor . “ They go to hospital more frequently , they ’ re seen by more senior people , they have ultrasounds they may not have otherwise . [ But ] this is not a high-risk condition for everyone .”
The Department of Health confirmed that the lower threshold would be included in its upcoming pregnancy summaries for health
professionals .
The RACGP , which was consulted
on the summaries , told the department that the GDM threshold “ can ,
and will , lead to overdiagnosis of
women ”. “ This has the potential to do significant harm ,” it added .
Early orchidopexy cuts testicular cancer risk
Kemal Atlay DOCTORS are being urged to recommend early corrective surgery for undescended testes following new evidence that the condition more than doubles the risk of later testicular cancer and fertility problems .
An NHMRC-funded study of 350,000 boys born in WA between 1970 and 1999 showed that those with undescended testes were 2.4 times more likely to develop testicular cancer , compared with unaffected boys .
It also found that boys with undescended testes had a 20 % lower chance of paternity in adulthood and were twice as likely to use assisted reproductive techniques ( ART ).
For every six months ’ delay in orchidopexy , there was a 6 % increase in the risk of testicular cancer , a 5 % increase in the use of ART and a 1 % reduction in paternity in adulthood , the researchers said .
The findings highlighted the importance of early surgery , said lead author Dr Francisco Schneuer , from the Children ’ s Hospital Westmead and University of Sydney .
“ Before this study , there was no evidence-based information on the impact of early surgery on the future risk of testicular cancer and infertility in adult males ,” said Dr Schneuer , who specialises in reproductive , maternal and child health .
“ Early surgery can reduce the risk of malignancy and male infertility , and ultimately has the potential to reduce future adult male reproductive disorders .”
Compliance with international guidelines for orchidopexy before
18 months of age was poor worldwide , the researchers said . Australian guidelines recommend a lower threshold for corrective surgery of between six and 12 months .
Low compliance with the guidelines could be partly explained by acquired undescended testes , said Dr Grahame Smith , a paediatric urology
specialist adviser for the Urological Society of Australia and New Zealand .
“ Some kids are born with descended testes , but one of them ascends as they get taller … [ in some cases ] by eight years of age , the testes have moved up into the groin ,” said Dr Smith .
The study also found a link between hypospadias and later testicular cancer , but this was inconclusive . Lancet Child & Adolescent Health 2018 ; online .
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