TARGET study - tighter or less tight glycaemic targets for women with gestational diabetes mellitus for reducing maternal and perinatal morbidity

TARGET study

• stepped-wedge, cluster-randomised trial
  • women with GDM (gestational diabetes), blinded to the targets in use, were eligible
  • all hospitals initially used less tight targets (fasting plasma glucose (FPG) <5.5 mmol/L (<99 mg/dL), 1-hour <8.0 mmol/L (<144 mg/dL), 2 hour postprandial <7.0 mmol/L (<126 mg/dL)) and every 4 months, 2 hospitals moved to use tighter targets (FPG <=5.0 mmol/L (<=90 mg/dL), 1-hour <=7.4 mmol/L (<=133 mg/dL), 2 hour postprandial <=6.7 mmol/L) (<=121 mg/dL)
  • primary outcome was large for gestational age
  • secondary outcomes assessed maternal and infant health
  • analyses were by intention to treat
    
    
• Study results
  • data were collected from 1,100 women with GDM (1,108 infants);
    • 598 women (602 infants) used the tighter targets and 502 women (506 infants) used the less tight targets
    • rate of large for gestational age was similar between the treatment target groups (88/599, 14.7% versus 76/502, 15.1%; adjusted relative risk [adjRR] 0.96, 95% confidence interval [CI] 0.66 to 1.40, P = 0.839)
    • composite serious health outcome for the infant of perinatal death, birth trauma, or shoulder dystocia was apparently reduced in the tighter group
    • secondary outcomes for the woman showed an apparent increase for the composite serious health outcome that included major haemorrhage, coagulopathy, embolism, and obstetric complications in the tighter group
      
      
• conclusions
  • tighter glycaemic targets in women with GDM compared to less tight targets did not reduce the risk of a large for gestational age infant, but did reduce serious infant morbidity, although serious maternal morbidity was increased. These findings can be used to aid decisions on the glycaemic targets women with GDM should use

Reference:

• Crowther CA, Samuel D, Hughes R, Tran T, Brown J, Alsweiler JM, et al. (2022) Tighter or less tight glycaemic targets for women with gestational diabetes mellitus for reducing maternal and perinatal morbidity: A stepped-wedge, cluster-randomised trial. PLoS Med 19(9): e1004087. https://doi.org/10.1371/journal.pmed.1004087