Comparison of screening for gestational diabetes mellitus by oral glucose tolerance tests done in the non-fasting (random) and fasting states

Abstract

Aim The Diabetes in Pregnancy Study Group of India (DIPSI) guidelines recommend the non-fasting 75-g oral glucose tolerance test (OGTT) as a single-step screening and diagnostic test for gestational diabetes mellitus (GDM). The aim of this study was to compare the DIPSI criteria with the World Health Organization (WHO) 1999 and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for GDM.MethodsA total of 1,031 pregnant women attending antenatal clinics in urban and rural Tamil Nadu, India, underwent a 75-g OGTT in both non-fasting and fasting states, 2–3 days apart. Venous plasma glucose was measured using an autoanalyser, and GDM was diagnosed by DIPSI, WHO 1999 and IADPSG criteria.ResultsOf the 83 women identified to have GDM by WHO 1999 criteria, only 23 were diagnosed by DIPSI criteria. Of the 106 women diagnosed to have GDM by the IADPSG criteria, only 24 were diagnosed by DIPSI. The DIPSI non-fasting OGTT 2-h VPG cut point of 140 mg/dl (7.8 mmol/l) had a very low sensitivity when compared to the WHO 1999 criteria (sensitivity 27.7 %, specificity 97.7 %) and IADPSG criteria (sensitivity 22.6 %, specificity 97.8 %).ConclusionsThe DIPSI non-fasting OGTT criteria cannot be recommended for diagnosis of GDM due to its low sensitivity. Thus, as a single-step diagnostic test for GDM, the fasting OGTT needs to be done. When this is not possible, the well-established two-step procedure using the 50-g glucose challenge test as an initial screening test, followed by the diagnostic fasting OGTT, can be continued.

Comparison of Screening for Gestational Diabetes Mellitusby IADPSG andDIPSI Guidelines: Importance of Fasting Blood Glucose Value in Its Diagnosis and Management

“…The diagnostic rate of GDM based only on the fasting value was 8.43%. This also correlates with the findings of other studies [11,16]. Our study shows thatFBG value has the highest diagnostic rate for GDM which is being completely ignored by DIPSI.We further assessed the severity of GDM by dividing the patients into two groups, one on MNT alone and the other requiring some form of pharmacotherapy.…”

“…A comparison of these studies is shown in Table 5. In our study, the total number of patients diagnosed to be GDM by IADPSGwas 11.97%, which is comparable to the study by V Mohan et al [16]. By DIPSI criteria, using only the 2hr value, GDM was diagnosed in 3.94% cases.…”

“…V Mohan et al compared DIPSI with IADPSG for diagnosis of GDM. They had incidence of 4.2% with DIPSI and 10.3% with IADPSG [16]. A comparison of these studies is shown in Table 5.…”

Gestational diabetes mellitus: In search of better screening and diagnostic pathway for Sri Lankan women

“…There are other studies showing poor sensitivity of GCT in diagnosing GDM (19,20). A recent study conducted by V Mohan, et al in India showed a very low sensitivity of non-fasting GCT when compared to the IADPSG criteria (sensitivity 22.6%, specificity 97.8%) (21). Other studies done in South Asian ethnicity as well as in Caucasians too have revealed poor sensitivity of 50g and 75g GCT (19,22,23).…”

Screening of gestational diabetes mellitus in antenatal women using DIPSI guidelines

“…Women in India with GDM Strategy (WINGS) while validating the non fasting DIPSI criteria, found that it has very low sensitivity (27.7%) compared to the WHO criteria and even lower sensitivity in comparison with IADPSG criteria (22.6%) although specificity was quite high. 17 A study from Delhi similarly reported that the no fasting DIPSI criteria results in low sensitivity. 18 Thus two independent studies from different geographic locations showed that the DIPSI no fasting OGTT is not suitable as a diagnostic test as it can miss a considerable number of women with GDM.…”