5.3.4.0 Fu­ture Con­sid­er­a­tions

The conflict­ing rec­om­men­da­tions from ex­pert groups un­der­score the fact that there are data to sup­port each strat­e­gy. A cost-‍benefit es­ti­ma­tion com­par­ing the two strate­gies con­clud­ed that the one-‍step ap­proach is cost-‍ef­fec­tive only if pa­tients with GDM re­ceive postde­liv­ery coun­sel­ing and care to pre­vent type 2 di­a­betes (89). The de­ci­sion of which strat­e­gy to im­ple­ment must there­fore be made based on the rel­a­tive val­ues placed on fac­tors that have yet to be mea­sured (e.g., will­ing­ness to change prac­tice based on cor­re­la­tion stud­ies rather than in­ter­ven­tion trial re­sults, avail­able in­fras­truc­ture, and im­por­tance of cost con­sid­er­a­tions).

As the IADPSG cri­te­ria (“one-‍step strat­e­gy”) have been adopt­ed in­ter­na­tion­al­ly, fur­ther ev­i­dence has emerged to sup­port im­proved preg­nan­cy out­comes with cost sav­ings (90) and may be the pre­ferred ap­proach. Data com­par­ing pop­u­la­tion-‍wide out­comes with one-‍step ver­sus two-‍step ap­proaches have been in­con­sis­tent to date (91,92). In ad­di­tion, preg­nan­cies com­pli­cat­ed by GDM per the IADPSG cri­te­ria, but not rec­og­nized as such, have com­pa­ra­ble out­comes to preg­nan­cies di­ag­nosed as GDM by the more strin­gent two-‍step cri­te­ria (93,94). There re­mains strong con­sen­sus that es­tab­lish­ing a uni­form ap­proach to di­ag­nos­ing GDM will benefit pa­tients, care­givers, and pol­i­cy mak­ers. Longer-‍term out­come stud­ies are cur­rently un­der­way.