目的系统检索、评价并总结国内外有关妊娠期糖尿病(gestational diabetes mellitus,GDM)高危人群生活方式指导预防GDM的最佳证据,为临床医护人员指导GDM高危人群预防GDM提供循证证据。方法系统检索BMJ Best Practice,Cochrane Library,...目的系统检索、评价并总结国内外有关妊娠期糖尿病(gestational diabetes mellitus,GDM)高危人群生活方式指导预防GDM的最佳证据,为临床医护人员指导GDM高危人群预防GDM提供循证证据。方法系统检索BMJ Best Practice,Cochrane Library,医脉通指南网、英国国家卫生与临床优化研究所、国际糖尿病与妊娠研究组、PubMed,Web of Science,Science Direct,澳大利亚实践指南(Australian clinical practice guidelines,ACPG)、中国知网、万方、CBM数据库和相关协会网站中GDM高危人群生活方式指导的最佳证据。检索时限为2015年6月至2022年6月。由2名研究者分别对纳入的文献进行质量评价。结果共纳入文献22篇,其中临床指南6篇,专家共识2篇,系统评价10篇,随机对照试验4篇。共总结了早期筛查、饮食指导、运动指导及体重管理指导四个方面17条最佳证据。结论该证据总结可为临床医护人员对GDM高危人群进行生活方式指导及制定生活方式干预方案提供循证参考依据。展开更多
Objective: To evaluate the value of fasting plasma glucose (FPG) in screening a high-risk population for gestational diabetes mellitus (GDM). Study design: D uring an 8-month period, 1,685 pregnant women underwent the...Objective: To evaluate the value of fasting plasma glucose (FPG) in screening a high-risk population for gestational diabetes mellitus (GDM). Study design: D uring an 8-month period, 1,685 pregnant women underwent the one-step 75 g ora l glucose tolerance test (OGTT) as a part of a universal screening program. The receiver operating characteristic (ROC) curve was used to analyze the performanc e of the FPG. Results: 333 (19.8%) women had GDM (WHO criteria). The area under the ROC curve of FPG to detect GDM was 0.639 (95%CI 0.603-0.674), which refle cted the degree of the FPG histogram overlap in women with and without GDM. A FP G threshold of 4.7 mmol/L reached the minimally acceptable sensitivity of 78.1% with a corresponding unacceptable specificity of 32.2%. 508 (31%) women were b elow this threshold, at a negative predictive value of 85.6%. The FPG at higher thresholds with acceptable specificity had poor sensitivity and positive predi ctive value to be useful. Conclusion: Though the high false positive rate at any FPG threshold with adequate sensitivity makes the FPG an inappropriate test for GDM screening, the FPG has the potential to avoid nearly one-third of the cumb ersome OGTTs at the expense of missing one-fifth of pregnant women with milder GDM.展开更多
文摘目的系统检索、评价并总结国内外有关妊娠期糖尿病(gestational diabetes mellitus,GDM)高危人群生活方式指导预防GDM的最佳证据,为临床医护人员指导GDM高危人群预防GDM提供循证证据。方法系统检索BMJ Best Practice,Cochrane Library,医脉通指南网、英国国家卫生与临床优化研究所、国际糖尿病与妊娠研究组、PubMed,Web of Science,Science Direct,澳大利亚实践指南(Australian clinical practice guidelines,ACPG)、中国知网、万方、CBM数据库和相关协会网站中GDM高危人群生活方式指导的最佳证据。检索时限为2015年6月至2022年6月。由2名研究者分别对纳入的文献进行质量评价。结果共纳入文献22篇,其中临床指南6篇,专家共识2篇,系统评价10篇,随机对照试验4篇。共总结了早期筛查、饮食指导、运动指导及体重管理指导四个方面17条最佳证据。结论该证据总结可为临床医护人员对GDM高危人群进行生活方式指导及制定生活方式干预方案提供循证参考依据。
文摘Objective: To evaluate the value of fasting plasma glucose (FPG) in screening a high-risk population for gestational diabetes mellitus (GDM). Study design: D uring an 8-month period, 1,685 pregnant women underwent the one-step 75 g ora l glucose tolerance test (OGTT) as a part of a universal screening program. The receiver operating characteristic (ROC) curve was used to analyze the performanc e of the FPG. Results: 333 (19.8%) women had GDM (WHO criteria). The area under the ROC curve of FPG to detect GDM was 0.639 (95%CI 0.603-0.674), which refle cted the degree of the FPG histogram overlap in women with and without GDM. A FP G threshold of 4.7 mmol/L reached the minimally acceptable sensitivity of 78.1% with a corresponding unacceptable specificity of 32.2%. 508 (31%) women were b elow this threshold, at a negative predictive value of 85.6%. The FPG at higher thresholds with acceptable specificity had poor sensitivity and positive predi ctive value to be useful. Conclusion: Though the high false positive rate at any FPG threshold with adequate sensitivity makes the FPG an inappropriate test for GDM screening, the FPG has the potential to avoid nearly one-third of the cumb ersome OGTTs at the expense of missing one-fifth of pregnant women with milder GDM.
