Topic Abstract

Background: Gestational diabetes mellitus (GDM), the most common medical complication of pregnancy, is defined as carbohydrate intolerance of variable degree, with an onset or first recognition occurring during pregnancy. GDM is associated with both maternal and neonatal complications. Furthermore, women with GDM are at high risk for future diabetes.

In 2007, we conducted an EPC evidence report to guide decisions about management of women with gestational diabetes for clinicians, researchers and policy makers ¹. Overall, evidence was graded either as low or insufficient strength to address the key questions. Because of the widespread deficiencies in the literature, it was challenging to identify specific gaps to target future research. For the evidence report, our research team identified broad research gaps and suggested higher quality clinical studies to address each key question.

Objective: The objective of this pilot project is to identify and organize research gaps, develop the gaps into researchable questions, and prioritize these research needs with stakeholder input related to the glucose management, labor management, postpartum risk assessment, and screening of women with gestational diabetes.

Approach: We will first further develop the research gaps from the original report, manuscripts derived from the evidence report, and from input from the original research team. These gaps will be organized based on the quality and quantity of evidence available, and the generalizability of evidence for an area or research question. Additional classification will include identification of gaps based on the PICOTS framework to identify more specifically what type of research is needed.

These gaps will be developed into researchable questions. A small, local stakeholder group will provide detailed input on the framing of questions, issues of study design, and feasibility. They will be engaged online and in a face-to-face meeting. Feedback will be used to revise the research questions and to develop the questionnaire for the prioritization exercise. A larger stakeholder group will prioritize the research questions using a Delphi approach with an online tool. This group will include clinicians, nutritionists, patients/consumers, funders and methodologists. Items will be aggregated and results summarized for the final report.

The final report will outline the final list of prioritized research questions, as well as a summary of the processes, including challenges and recommendations for change. The systematic framework proposed for identifying and describing research gaps may be unique and most applicable to future reports with uniformly low or insufficient strength of evidence.

Reference

1. Nicholson WK, Wilson LM, Witkop CT, Baptiste-Roberts K, Bennett WL, Bolen S, Barone BB, Golden SH, Gary TL, Neale DM, Bass EB. Therapeutic Management, Delivery, and Postpartum Risk Assessment and Screening in Gestational Diabetes. Evidence Report/Technology Assessment No. 162 (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018.) AHRQ Publication No. 08-E004. Rockville, MD: Agency for Healthcare Research and Quality. March 2008.