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Different intensities of glycaemic control for pregnant women with pre-existing diabetes

Overview of attention for article published in Cochrane database of systematic reviews, May 2016
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Mentioned by

twitter
7 tweeters
facebook
1 Facebook page

Citations

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18 Dimensions

Readers on

mendeley
142 Mendeley
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Title
Different intensities of glycaemic control for pregnant women with pre-existing diabetes
Published in
Cochrane database of systematic reviews, May 2016
DOI 10.1002/14651858.cd008540.pub4
Pubmed ID
Authors

Philippa Middleton, Caroline A Crowther, Lucy Simmonds

Abstract

The optimal glycaemic control target in pregnant women with pre-existing diabetes is unclear, although there is a clear link between high glucose concentrations and adverse birth outcomes. To assess the effects of different intensities of glycaemic control in pregnant women with pre-existing type 1 or type 2 diabetes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2016) and planned to search reference lists of retrieved studies. We included randomised controlled trials comparing different glycaemic control targets in pregnant women with pre-existing diabetes. Two review authors independently assessed trials for inclusion, conducted data extraction, assessed risk of bias and checked for accuracy. We assessed the quality of the evidence using the GRADE approach. We included three trials, all in women with type 1 diabetes (223 women and babies). All three trials were at high risk of bias due to lack of blinding, unclear methods of randomisation and selective reporting of outcomes. Two trials compared very tight (3.33 to 5.0 mmol/L fasting blood glucose (FBG)) with tight-moderate (4.45 to 6.38 mmol/L) glycaemic control targets, with one trial of 22 babies reporting no perinatal deaths orserious perinatal morbidity (evidence graded low for both outcomes). In the same trial, there were two congenital anomalies in the very tight, and none in the tight-moderate group, with no significant differences in caesarean section between groups (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.49 to 1.73; evidence graded very low). In these two trials, glycaemic control was not significantly different between the very tight and tight-moderate groups by the third trimester, although one trial of 22 women found significantly less maternal hypoglycaemia in the tight-moderate group.In a trial of 60 women and babies comparing tight (≤ 5.6 mmol/L FBG); moderate (5.6 to 6.7 mmol/L); and loose (6.7 to 8.9 mmol/L) glycaemic control targets, there were two neonatal deaths in the loose and none in the tight or moderate groups (evidence graded very low). There were significantly fewer women with pre-eclampsia (evidence graded low), fewer caesarean sections (evidence graded low) and fewer babies with birthweights greater than 90th centile (evidence graded low) in the combined tight-moderate compared with the loose group.The quality of the evidence was graded low or very low for important outcomes, because of design limitations to the studies, the small numbers of women included, and wide confidence intervals crossing the line of no effect. Many of the important outcomes were not reported in these studies. In a very limited body of evidence, few differences in outcomes were seen between very tight and tight-moderate glycaemic control targets in pregnant women with pre-existing type 1 diabetes, including actual glycaemic control achieved. There is evidence of harm (increased pre-eclampsia, caesareans and birthweights greater than 90th centile) for 'loose' control (FBG above 7 mmol/L). Future trials comparing interventions, rather than glycaemic control targets, may be more feasible. Trials in pregnant women with pre-existing type 2 diabetes are required.

Twitter Demographics

The data shown below were collected from the profiles of 7 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 142 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 <1%
Spain 1 <1%
United States 1 <1%
Unknown 139 98%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 25 18%
Researcher 24 17%
Student > Master 19 13%
Other 14 10%
Student > Ph. D. Student 13 9%
Other 26 18%
Unknown 21 15%
Readers by discipline Count As %
Medicine and Dentistry 68 48%
Nursing and Health Professions 20 14%
Social Sciences 6 4%
Psychology 5 4%
Biochemistry, Genetics and Molecular Biology 3 2%
Other 12 8%
Unknown 28 20%

Attention Score in Context

This research output has an Altmetric Attention Score of 4. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 21 December 2017.
All research outputs
#3,314,582
of 12,618,488 outputs
Outputs from Cochrane database of systematic reviews
#6,309
of 10,380 outputs
Outputs of similar age
#75,255
of 261,476 outputs
Outputs of similar age from Cochrane database of systematic reviews
#123
of 184 outputs
Altmetric has tracked 12,618,488 research outputs across all sources so far. This one has received more attention than most of these and is in the 73rd percentile.
So far Altmetric has tracked 10,380 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 20.2. This one is in the 39th percentile – i.e., 39% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 261,476 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 71% of its contemporaries.
We're also able to compare this research output to 184 others from the same source and published within six weeks on either side of this one. This one is in the 33rd percentile – i.e., 33% of its contemporaries scored the same or lower than it.