Fasting Glycemia as Screening Tool to Rule-Out Gestational Diabetes in Low-Risk Population

Maesa, José-María; Fernandez-Riejos, Patricia; Sánchez‐Margalet, Víctor; González-Rodríguez, Concepción

doi:10.7754/clin.lab.2017.170920

Cited by 2 publications

(4 citation statements)

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“…Further validation is required to adequately assess feasibility for self-OGTT at home, but current findings allude to self-OGTT's potential as an alternative option to the vOGTT to screen for T2DM among these at-risk women in clinical settings. [14][15][16][17][18][19] Our study also shows good sensitivity (94.1%) and NPV (91.7%) for the cOGTT in detecting abnormal glucose readings (prediabetes or diabetes range). The comparability between the cOGTT and vOGTT alludes to the former in identifying people with prediabetes or T2DM.…”

Section: Discussionmentioning

confidence: 59%

“…12 13 OGTT is inconvenient, time-consuming, labourintensive, and relatively costly, and often perceived as unpleasant. [14][15][16][17][18][19] Local Asian women with GDM reported 'unpleasant OGTT experience' as a barrier to postpartum T2DM screening. 18 The challenges of conducting OGTT have prompted the WHO to publish a set of conversion values for capillary and venous plasma glucose values.…”

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confidence: 99%

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Self-administered oral glucose tolerance test with capillary glucose measurements for the screening of diabetes mellitus in high-risk adults: a feasibility study

Tan

et al. 2021

BMJ Open Diab Res Care

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IntroductionEarly diagnosis of prediabetes based on blood sampling for the oral glucose tolerance test (OGTT) is crucial for intervention but multiple barriers hinder its uptake. This study aimed to assess the feasibility and precision of a self-administered capillary OGTT for type-2 diabetes mellitus (T2DM) in high-risk individuals.Research design and methodsParticipants with history of gestational diabetes or prediabetes were recruited in primary care. Due to their prediabetic status and previous diagnosis of gestational diabetes mellitus, a proportion of participants had previous experience doing OGTT. They self-administered the capillary OGTT and concurrently their venous glucose samples were obtained. They filled a questionnaire to collect their demographic information, views of their capillary OGTT, and their preferred site of the test.ResultsAmong 30 participants enrolled in this feasibility study, 93.3% of them felt confident of performing the capillary OGTT themselves, and 70.0% preferred the test at home. Older, less educated participants found it less acceptable. Mean capillary glucose values were significantly higher than venous glucose values, with mean difference at 0.31 mmol/L (95% CI 0.13 to 0.49) at fasting, and 0.47 mmol/L (95% CI 0.12 to 0.92) 2 hours post-OGTT. Capillary and venous glucose measurements were correlated for fasting (r=0.95; p<0.001) and 2-hour-post-OGTT (r=0.95;p<0.001). The Fleiss-Kappa Score (0.79, p<0.0001) indicated fair agreement between the two methods. The capillary OGTT had excellent sensitivity (94.1%) and negative predictive value (NPV=91.7%) in identifying prediabetes or T2DM status, vis-a-vis to venous glucose samples.ConclusionSelf-administered capillary OGTT is feasible and acceptable, especially among younger adults, with excellent sensitivity and NPV compared with plasma-based OGTT.

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Section: Discussionmentioning

confidence: 59%

mentioning

confidence: 99%

Self-administered oral glucose tolerance test with capillary glucose measurements for the screening of diabetes mellitus in high-risk adults: a feasibility study

Tan

et al. 2021

BMJ Open Diab Res Care

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“…91 A study evaluating FPG as a screening tool to rule-out GDM in a lowrisk population found that women with FPG ≤3.4 mmol/L were at low risk of developing GDM with a sensitivity of 91.3%, thereby avoiding a two-step screening in 10% of their population. 92 Some authors suggest that sensitivity and specificity for risk-factor based GDM screening could be considerably improved by using clinical risk prediction models that include combinations of several risk indicators in combination with FPG for improved prediction. For example, an estimation model developed by an Austrian research group (including history of GDM, glycosuria, family history of diabetes, age, preconception dyslipidemia and ethnic origin, in addition to FPG) showed that it was accurate for detecting GDM in participants with normal FPG.…”

Section: Additional Screening Methodsmentioning

confidence: 99%

“… 91 A study evaluating FPG as a screening tool to rule-out GDM in a low-risk population found that women with FPG ≤3.4 mmol/L were at low risk of developing GDM with a sensitivity of 91.3%, thereby avoiding a two-step screening in 10% of their population. 92 …”

Section: Overview Of the Included Publicationsmentioning

confidence: 99%

An Update on Screening Strategies for Gestational Diabetes Mellitus: A Narrative Review

Minschart¹,

Beunen²,

Benhalima³

2021

DMSO

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Gestational diabetes mellitus (GDM) is a frequent medical complication during pregnancy. Screening and diagnostic practices for GDM are inconsistent across the world. This narrative review includes data from 87 observational studies and randomized controlled trials (RCTs), and aims to give an overview of the current evidence on screening strategies and diagnostic criteria for GDM. Screening in early pregnancy remains controversial and studies show conflicting results on the benefit of screening and treatment of GDM in early pregnancy. Implementing the one-step "International Association of Diabetes and Pregnancy Study Groups" (IADPSG) screening strategy at 24-28 weeks often leads to a substantial increase in the prevalence of GDM, without conclusive evidence regarding the benefits on pregnancy outcomes compared to a two-step screening strategy with a glucose challenge test (GCT). In addition, RCTs are needed to investigate the impact of treatment of GDM diagnosed with IADPSG criteria on long-term maternal and childhood outcomes. Selective screening using a risk-factor-based approach could be helpful in simplifying the screening algorithm but carries the risk of missing significant proportions of GDM cases. A two-step screening method with a 50g GCT and subsequently a 75g oral glucose tolerance test (OGTT) with IADPSG could be an alternative to reduce the need for an OGTT. However, to have an acceptable sensitivity to screen for GDM with the IADPSG criteria, the threshold of the GCT should be lowered from 7.8 to 7.2 mmol/L. A pragmatic approach to screen for GDM can be implemented during the COVID-19 pandemic, using fasting plasma glucose (FPG), HbA1c or even random plasma glucose (RPG) to reduce the number of OGTTs needed. However, usual guidelines and care should be resumed as soon as the COVID pandemic is controlled.

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Fasting Glycemia as Screening Tool to Rule-Out Gestational Diabetes in Low-Risk Population

Abstract: We proposed that women with fasting glycemia ≤ 62 mg/dL, (S = 91.3%, NPV = 98.79% and LR- = 0.87) are in low risk of suffering gestational diabetes, which means that 10% of our population would not undergo the glucose challenge test.

Cited by 2 publications

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Self-administered oral glucose tolerance test with capillary glucose measurements for the screening of diabetes mellitus in high-risk adults: a feasibility study

Self-administered oral glucose tolerance test with capillary glucose measurements for the screening of diabetes mellitus in high-risk adults: a feasibility study

An Update on Screening Strategies for Gestational Diabetes Mellitus: A Narrative Review

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