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Gestational DiabetesUPDATE-GDMNCT06401629

Outcomes After Unified Versus Standard GDM Diagnosis

A study testing NPRP criteria and IADPSG criteria in people with Gestational Diabetes and Diagnosis, run by Qatar University.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

Gestational diabetes mellitus (GDM) is a condition that can affect pregnant women during pregnancy and may cause complications for the mother and the baby. Therefore, early and accurate detection is necessary to provide the woman and the baby with better health outcomes. Read more about this study

Who is it for?
Ages 18 to 45 years, women only
Conditions the study is for
Gestational Diabetes, Diagnosis, Pregnancy
What is being tested?
NPRP criteria and IADPSG criteria
Could I receive a placebo?
No, everyone receives an active treatment
How many people
2,650 participants
Where
No sites listed yet
Study dates
1 Jan 2025to 1 Jun 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 45 years
  • Women only
  • No healthy volunteers
  • Adult

Who may be able to join

  • This will include broad eligibility criteria of age 18-45 years with or without risk factors at first antenatal care (ANC) visit who are willing to undergo testing at 24-28 weeks and able to provide informed consent.

Who cannot join

  • a multiple pregnancy at the time of screening, pre-existing diabetes (T1DM, T2DM)
  • any medical condition affecting glucose metabolism or the results of the GTT (e.g., Cushing's syndrome, bariatric surgery history)
  • known history of major conditions that could interfere with the study or pregnancy outcomes (e.g., severe liver, renal or cardiovascular disorders, chronic infections).

Trial locations and contacts

No sites are listed yet. Contact the study team or a site near you to ask about taking part.

Suhail A. Doi, MBBS, PhD contact

+974 66001271

sdoi@qu.edu.qa

Mohammed Bashir, MD contact

mbashir@hamad.qa

About this study

Official title: The UPDATE-GDM Study: OUtcomes After NPRP anD ConventionAl CriTEria for GDM Diagnosis: A Pragmatic Randomised Trial

Gestational diabetes mellitus (GDM) is a condition that can affect pregnant women during pregnancy and may cause complications for the mother and the baby. Therefore, early and accurate detection is necessary to provide the woman and the baby with better health outcomes. Currently, the most commonly used criteria to detect GDM is the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criterion. However, there is a suggestion that it results in over-diagnosis of GDM, and newer methods of diagnosis have been proposed. One such proposal is to have more than a binary outcome of assessment of dysglycemia in pregnancy. The investigator group created this criterion known as the National Priorities Research Program (NPRP) criterion. This clinical trial compares the IADPSG to the NPRP criteria in pregnant women in Qatar to determine if this newer method mitigates overdiagnosis and more accurately identifies women at risk of complications.

Read the detailed description

This research project explores a crucial aspect of maternal and fetal health: the diagnosis of gestational diabetes mellitus (GDM), a condition that poses risks to both pregnant women and the babies. Gestational diabetes is a condition that can develop during pregnancy, characterized by dysglycemia and associated risks of complications such as pre-eclampsia, cesarean delivery, and macrosomia. For the baby, it raises the risk of developing obesity, type 2 diabetes later in life, and metabolic syndrome. Therefore, early and accurate diagnosis is paramount to manage and mitigate these risks. The IADPSG (International Association of Diabetes and Pregnancy Study Groups) criteria, the current standard for GDM diagnosis, has been widely adopted due to its putative sensitivity in detecting GDM and potential for reducing GDM-related complications. However, this method is not without its limitations, including the risk of over- or under-diagnosis of GDM. This project will investigate the efficacy of an alternative diagnostic method, the National Priorities Research Program (NPRP) criteria, against the conventional IADPSG criteria, diagnosis usually being undertaken between the 24th and 28th weeks of pregnancy. The NPRP criteria are based on a unified assessment of the oral glucose tolerance test (GTT), which could offer a four-level classification of dysglycemia in pregnancy as opposed to the binary diagnosis by the IADPSG criteria, thus having the added benefit of glycemic risk stratification during pregnancy. By comparing the outcomes of pregnancies diagnosed using the NPRP criteria against those diagnosed using the IADPSG criteria, the investigators aim to assess whether the NPRP criteria can provide improved outcomes (Bashir et al. 2021) in terms of maternal and fetal health through better informed GDM-related decision-making. In addition, this study proposes the NPRP criteria as potentially able to mitigate over- and under-diagnosis of GDM. This study will employ a parallel-group, prospective, randomized, pragmatic, controlled trial design and the study investigators will work closely with a cohort of pregnant women throughout pregnancy, employing both diagnostic methods to evaluate their impact on the health of the mother and the baby. The evaluation will not only focus on the immediate outcomes during pregnancy but will also aim to follow up on longer-term metabolic health implications for both mother and child post-delivery after the trial is completed and if the participant consents to such additional follow-up. The significance of this research lies in its potential to transform the current practices in GDM diagnosis, by offering evidence on the effectiveness and benefits of the NPRP criteria, thus paving the way for a shift towards a more patient-centered approach to the diagnosis of gestational diabetes. Determining if the NPRP criteria can lead to better health outcomes for mothers and babies can have profound implications for maternal and child health. Improved diagnostic methods could lead to more timely interventions, reducing the prevalence of complications associated with gestational diabetes and improving the quality of life for countless families. Through this study, the investigators hope to make a significant contribution to the well-being of pregnant women and babies, ensuring a healthier start for the next generation.

Being tested
NPRP criteria, IADPSG criteria
Keywords
Gestational Diabetes Mellitus, IADPSG, NPRP, Obesity, Dysglycemia, High-risk Pregnancy
Medical subject headings
Diabetes, Gestational, Disease, Obesity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • NPRP criteriaDiagnostic test

    Under the NPRP criterion, the plasma glucose level at each time point (TP1, TP2, and TP3) is multiplied by its weight (Doi et al. 2022), and the sum of these products yields the unified Doi's Weighted Average Glucose (dwAG) value for each woman. The dwAG is then categorized into four groups: a dwAG of 6.8 or lower, >6.8 to ≤7.5, >7.5 to ≤8.6, and above 8.6 mmol/L, indicating normal gestational glycemia (NGG), impaired gestational glycemia (IGG), gestational diabetes mellitus (GDM), and high-risk gestational diabetes mellitus (hGDM), respectively (Doi et al. 2022).

  • IADPSG criteriaDiagnostic test

    The IADPSG criteria define GDM as any one of the three-time points above specific thresholds: the time point prior to glucose ingestion (TP1) is considered abnormal when the fasting plasma glucose (FPG) value is ≥ 5.1 mmol/L, the 1-hour time-point after glucose ingestion (TP2) is considered abnormal when the value is ≥ 10 mmol/L, and the 2-hour time-point after glucose ingestion (TP3) is considered abnormal when the Post-Load Plasma Glucose levels are ≥ 8.5 mmol/L (Metzger et al. 2010). Put simply, meeting any one of these cut-offs results in a GDM diagnosis, regardless of whether the other time points show normal values or not (Metzger et al. 2010).

Study groups in NCT06401629
Study groupRoleWhat they receive
National Priorities Research Program (NPRP) diagnostic criterionExperimentalInterventional diagnostic strategy
Receives: Diagnostic Test: NPRP criteria
International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criterionActive comparatorControl diagnostic strategy
Receives: Diagnostic Test: IADPSG criteria

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. large for gestational age (LGA)

    infants who weigh > 90th percentile for gestational age

    Measured: Through pregnancy completion, an average of 9 months

Secondary outcomes (11)
  1. Average plasma glucose

    Report: Group mean and standard deviation (SD); for both pre-prandial and 2 hour postprandial glucose

    Measured: Through pregnancy completion, an average of 9 months

  2. Glycemic targets unmet

    Reports: Number with any of the following: Need to move to insulin; readmission for poor glycemic control; intervention targets unmet

    Measured: Through pregnancy completion, an average of 9 months

  3. Adverse events related to treatment

    Report: Number (by group) reporting any GI or systemic adverse effects and split by:

    1. Maternal hypoglycemia (glucose < 4 mmol/L or who received inter-venous glucose rescue)
    2. Others (excluding hypoglycemia)

    Measured: Through pregnancy completion, an average of 9 months

  4. Total weight gain in pregnancy (kg)

    Report: Group means and SD of total weight gained during pregnancy

    Measured: Through pregnancy completion, an average of 9 months

  5. Birth weight (newborn's weight at birth)

    Report: Numbers (by group) with LGA as well as group means and SD of continuous birth weight

    Measured: Through pregnancy completion, an average of 9 months

  6. Hypoglycemia within 1 hour of birth

    Report: Number (by group) with hypoglycemia (<=1.65 mmol/L)

    Measured: Through pregnancy completion, an average of 9 months

  7. Neonatal composite morbidity and mortality outcome

    Report: number (by group) of any neonatal death, stillbirth, or neonatal intensive care unit (NICU) admission and also split by:

    1. NICU admission > 24 hours
    2. Neonatal death (within 28 days of birth)
    3. Stillbirth

    Measured: Through pregnancy completion, an average of 9 months

  8. Assisted labor/delivery (including cesarean)

    Report: Number (by group) of all assisted deliveries as well as split by:

    1. Non-cesarean: any of induction/augmentation/vacuum extraction/operative vaginal delivery etc.
    2. Elective/Emergency Cesarean Section
    3. Primary/repeated Cesarean Section

    Measured: Through pregnancy completion, an average of 9 months

  9. Preterm delivery

    Report: Number (by group) with delivery at <37 weeks of gestation

    Measured: Through pregnancy completion, an average of 9 months

  10. Peripartum infection

    Report: Number (by group) of any of chorioamnionitis, urinary tract infections (UTI) or any other maternal infections

    Measured: Through pregnancy completion, an average of 9 months

  11. Pregnancy induced hypertension (PIH) or pre-eclampsia/ eclampsia

    Report: Number (by group) of all PIH as well as split by

    1. Eclampsia/pre-eclampsia
    2. Other PIH

    Measured: Through pregnancy completion, an average of 9 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 May 2024
  2. Study start1 Jan 2025 (estimated)
  3. Primary completion1 Jun 2026 (estimated)
  4. Study completion1 Jun 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Randomised
Intervention model
Parallel groups
Model description
This study will be designed as a multicentre, two-arm, parallel, pragmatic, randomized controlled trial conducted at two participating hospitals in Qatar. This design allows for an assessment of interventions in real-world settings and offers practical insights into the clinical utility of different diagnostic criteria. All pregnancies will be randomly assigned to the NPRP or IADPSG approach (1:1 ratio) at their first prenatal visit using an electronically generated random assignment procedure; this assignment will be provided to the lab within CERNER at the time of reporting GDM screening results (typically done at 24-28 weeks' gestation). If screening was ordered more than once, the same assigned result type will be presented to providers each time.
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
2,650 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06401629
Sponsor's protocol ID
ARG02-0403-240134
Acronym
UPDATE-GDM
Status last verified
May 2024
First submitted
1 May 2024
Last updated
8 May 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: No plans at this point.

Publications

  • Doi SAR, Bashir M, Sheehan MT, Onitilo AA, Chivese T, Ibrahim IM, Beer SF, Furuya-Kanamori L, Abou-Samra AB, McIntyre HD. Unifying the diagnosis of gestational diabetes mellitus: Introducing the NPRP criteria. Prim Care Diabetes. 2022 Feb;16(1):96-101. doi: 10.1016/j.pcd.2021.08.006. Epub 2021 Aug 19.

    PubMed 34419366
  • International Association of Diabetes and Pregnancy Study Groups Consensus Panel; Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva Ad, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010 Mar;33(3):676-82. doi: 10.2337/dc09-1848. No abstract available.

    PubMed 20190296
  • Bashir M, Syed A, Furuya-Kanamori L, Musa OAH, Mohamed AM, Skarulis M, Thalib L, Konje JC, Abou-Samra AB, Doi SAR. Core outcomes in gestational diabetes for treatment trials: The Gestational Metabolic Group treatment set. Obes Sci Pract. 2021 Feb 3;7(3):251-259. doi: 10.1002/osp4.480. eCollection 2021 Jun.

    PubMed 34123392

Questions about this trial

What is this clinical trial studying?

A study testing NPRP criteria and IADPSG criteria in people with Gestational Diabetes and Diagnosis, run by Qatar University.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 8 May 2024. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Suhail A. Doi, MBBS, PhD (+974 66001271, sdoi@qu.edu.qa), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

large for gestational age (LGA) (time frame: Through pregnancy completion, an average of 9 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06401629, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 May 2024.

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