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Diabetes care during pregnancy reduces risk of obese children

Rating

4 Star

Diabetes care during pregnancy reduces risk of obese children

Our Review Summary

The Cleveland paper published a shortened version of a story originally reported by the Associated Press. The story describes results from a large study that suggest treatment of maternal high blood sugars in pregnancy may lower risk of overweight or obese children at age 5 or 7.  The story does give absolute benefits (proportions of children who are overweight or obese), does obtain a quote from a source apparently not affiliated with the research, does describe treament options, and does discuss what’s new about this study (e.g. women who have blood sugar, but not necessarily high enough for a diagnosis of gestational diabetes may benefit from diabetes treatment in pregnancy).  What’s missing is a description of the strength of the evidence–it’s not clear whether this is from a randomized trial, which is the gold standard–or from some other less robust study design.  Because of this, readers don’t know how to gauge the new findings.  Another missing element is failure to note that women were classified as receiving treatment if their test results placed them in the category that would have been routine for intervention to be provided. Whether and what intervention women received is not addressed and this weakness is important.  There is also no mention of costs of treatment for what would be a new group of people being treated and there is no discussion of risks of treatment, which in this case, could include severe episodes of low blood sugar, particularly for those on insulin. 

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The article does not mention costs. 

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story provides absolute proportions of children who were overweight or obese at 5 or 7 years old.  Groups compared included children of those mothers with normal glucose levels, children of those with a diabetes diagnosis who were treated, and children of those with high blood sugar levels who were not treated.  Although it’s not entirely clear which group actually received treatment. 

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The study does not mention any harms of treatment for high blood sugar, which could potentially include severe episodes of low blood sugar (if treated with insulin).  Would also have been helpful to say more about the lifestyle/nutrition interventions and to note that they have not been found to cause harm, though the effects of materal stress/worry and the costs of blood glucose monitoring are not well studied.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story does not make it clear what type of evidence the findings are based on.  For instance, it’s not clear if results are from a randomized trial (the gold standard) or some other study design.  An astute reader may be able to infer that this is not a randomized clinical trial from the statement that data were "analyzed", but one also doesn’t know if the design was prospective or retrospective, which would add to knowledge about the strength of the study.  The fact that we actually don’t know what treatment women actually got is also not clearly discussed. 

Does the story commit disease-mongering?

Satisfactory

There is no obvious embellishment or mistatement about gestational diabetes.  The article provides a brief, but accurate description of what it is.  The lead line "women who develop diabetes during pregnancy" is somewhat misleading because without clarification of the often transient nature of gestational diabetes, readers could think it means Type II diabetes – women who develop and continue to have diabetes. It would be preferable to define and use the term gestational diabetes or pregnancy-related diabetes much earlier.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

There is a quote from a researcher at Northwestern University who apparently is not affiliated with the latest findings. 

Does the story compare the new approach with existing alternatives?

Satisfactory

The story mentions treatment approaches of gestational diabetes, including diet, exercise, and insulin, which are appropriate.  The article does not note the option of not treating (especially in the lower range) which is advocated by some.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

Assuming "treatment" in this case is "exercise, a special diet, or insulin," the article does imply that these are available.  Most, if not all, people will understand that treatment for high blood sugar is readily available.  What’s new is that treatment of women with blood sugar that is high, but not high enough for a diagnosis of diabetes, may benefit from treatment with exercise, diet, or insulin as well. 

A more important wrinkle in this particular study is that "treatment" is inferred by practice patterns used at Kaiser and no individual-level data is available to determine if the women in the group that would have been provided with counseling/intervention of gestational diabetes actually received that counsel or acted on it. Thus the "treated group" is actually those who met gestational diabetes criteria by National Diabetes Data Group criteria – thus they are really the treatment eligible group among whom some (likely large) group received some completely not specified treatment.

Does the story establish the true novelty of the approach?

Satisfactory

Treatment for gestational diabetes is not new, although the story does not explicitly state this.  What the story implies is that diagnosis and treatment of diabetes at lower blood sugar thresholds than those currently treated may have a benefit for children, although more studies are needed.  Diagnosing and treating more pregnant women with high blood sugar who don’t necessarily meet the traditional diabetes diagnosis would be new and there is some discussion around this. 

Does the story appear to rely solely or largely on a news release?

Satisfactory

Since the story used at least one independent perspective, it does not appear to have relied soley or largely on a news release.

Total Score: 7 of 10 Satisfactory

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