Open Access Study protocol

Screening uptake rates and the clinical and cost effectiveness of screening for gestational diabetes mellitus in primary versus secondary care: study protocol for a randomised controlled trial

Angela O’Dea1*, Jennifer J Infanti1, Paddy Gillespie2, Olga Tummon1, Samuel Fanous1, Liam G Glynn3, Brian E McGuire4, John Newell5 and Fidelma P Dunne1

Author Affiliations

1 School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland

2 J.E. Cairnes School of Business & Economics, Cairnes Building, National University of Ireland Galway, Galway, Ireland

3 Discipline of General Practice, School of Medicine, 1 Distillery Road, National University of Ireland Galway, Galway, Ireland

4 School of Psychology, National University of Ireland Galway, University Road, Galway, Ireland

5 HRB Clinical Research Facility Galway, National University of Ireland Galway, University Road, Galway, Ireland

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Trials 2014, 15:27  doi:10.1186/1745-6215-15-27

Published: 17 January 2014

Abstract

Background

The risks associated with gestational diabetes mellitus (GDM) are well recognized, and there is increasing evidence to support treatment of the condition. However, clear guidance on the ideal approach to screening for GDM is lacking. Professional groups continue to debate whether selective screening (based on risk factors) or universal screening is the most appropriate approach. Additionally, there is ongoing debate about what levels of glucose abnormalities during pregnancy respond best to treatment and which maternal and neonatal outcomes benefit most from treatment. Furthermore, the implications of possible screening options on health care costs are not well established. In response to this uncertainty there have been repeated calls for well-designed, randomised trials to determine the efficacy of screening, diagnosis, and management plans for GDM. We describe a randomised controlled trial to investigate screening uptake rates and the clinical and cost effectiveness of screening in primary versus secondary care settings.

Methods/Design

This will be an unblinded, two-group, parallel randomised controlled trial (RCT). The target population includes 784 women presenting for their first antenatal visit at 12 to 18 weeks gestation at two hospitals in the west of Ireland: Galway University Hospital and Mayo General Hospital. Participants will be offered universal screening for GDM at 24 to 28 weeks gestation in either primary care (n = 392) or secondary care (n = 392) locations. The primary outcome variable is the uptake rate of screening. Secondary outcomes include indicators of clinical effectiveness of screening at each screening site (primary and secondary) including gestational week at time of screening, time to access antenatal diabetes services for women diagnosed with GDM, and pregnancy and neonatal outcomes for women with GDM. In addition, parallel economic and qualitative evaluations will be conducted. The trial will cover the period from the woman’s first hospital antenatal visit at 12 to 18 weeks gestation, until the completion of the pregnancy.

Trial registration

Current Controlled Trials: ISRCTN02232125

Keywords:
Gestational diabetes mellitus; Screening; Primary care; Secondary care; Randomised controlled trial