Gestational Diabetes Mellitus: Using the Fasting Plasma Glucose Level to Simplify the International Association of Diabetes and Pregnancy Study Groups Diagnostic Algorithm in an Adult South Asian Population

Agarwal, Mukesh; Punnose, John; Sukhija, Komal; Sharma, Asha; Choudhary, Naimaa

doi:10.1016/j.jcjd.2017.12.009

Cited by 16 publications

(25 citation statements)

References 15 publications

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“…The reproducibility and accuracy of the OGTT is questioned by some authors [ 15 , 16 ]. Different studies showed that the use of fasting glycemia could be a reliable screening and diagnostic method of GDM as much as OGTT, both alone or with the postprandial plasma glucose levels [ 27 – 29 ]. Furthermore, a recent research showed that a single fasting plasma glucose measurement, such as OGTT, can provide a valid and predictive tool for the occurrence of unfavorable neonatal outcome [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Continuous Glucose Monitoring in Women with Normal OGTT in Pregnancy

Tartaglione

Stasio

Sirico

et al. 2021

Journal of Diabetes Research

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Continuous glucose monitoring (CGM) might be an effective tool to improve glycemic control in gestational diabetes mellitus (GDM). Few data are available about its utilization as a diagnostic tool to find potential alterations of glycemia in subjects with normal oral glucose tolerance test (OGTT). In this preliminary prospective real-life observational study, we aimed to analyze the glycemic pattern in normal and gestational diabetes mellitus (GDM) women by continuous glucose monitoring (CGM) in order to detect potential differences between the two groups and glycemic alterations despite a normal OGTT. After the screening for GDM, subjects were connected to a CGM system for seven consecutive days. The areas under the curve of the first 60 minutes after each meal and 60 minutes before breakfast were analyzed. Women with normal OGTT that during CGM showed impaired glycemic values (more than 95 fasting or more than 140 one hour after meals or more than 120 two hours after meals) performed one week of self-monitoring of blood glucose (SMBG). After OGTT, 53 women considered normal and 46 affected by GDM were included. CGM parameters did not show any differences between the two groups with impaired glycemic excursions found in both groups. After CGM period, 33 women with normal OGTT showed abnormal glycemic patterns. These 33 women then performed one week of SMBG. After evaluation of one week of SMBG, 21 required diet therapy and 12 required insulin treatment and were followed until the delivery. An increase in gestational weight gain was observed in normal women with normal OGTT but this was not significant. No significant data were found regarding neonatal outcomes in the two groups of women. In conclusion, CGM use in pregnancy might help to detect glycemic fluctuations in women with normal OGTT, improving their treatment and outcomes.

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Section: Discussionmentioning

confidence: 99%

Continuous Glucose Monitoring in Women with Normal OGTT in Pregnancy

Tartaglione

Stasio

Sirico

et al. 2021

Journal of Diabetes Research

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“…glucose load, the timing of glucose estimations, and the diagnostic threshold values. To decrease the number of OGTTs performed for GDM diagnosis, alternate screening tests such as fasting plasma glucose (FPG), glycated haemoglobin (HbA1c), and fructosamine have been proposed by several researchers [6][7][8]. HbA1c measurement has several advantages over OGTT, such as requiring a single non fasting sample, having greater pre-analytic stability and reproducibility, and showing no interference from acute stressful conditions.…”

Section: Introductionmentioning

confidence: 99%

Glycated haemoglobin in the first trimester: A predictor of gestational diabetes mellitus in pregnant Asian Indian women

Punnose

Malhotra

Sukhija

et al. 2020

Diabetes Research and Clinical Practice

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“…[27][28][29] Although an FPG ≥5.1 mmol/L is 100% specific for a diagnosis of GDM, the sensitivity of this diagnostic threshold varies between countries and ethnicities in both lowand high-risk populations. [13,16,30,31] When retrospectively applied to the HAPO study cohort, the mean proportion of GDM-positive diagnoses based on an elevated FPG was 55% (range 24 -74%), and this figure varied between and within countries. [13] The underlying mechanism responsible for this variability is unknown.…”

Section: Discussionmentioning

confidence: 99%

Fasting plasma glucose and risk factor assessment: Comparing sensitivity and specificity in identifying gestational diabetes in urban black African women

et al. 2019

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Background. Identifying women with gestational diabetes mellitus (GDM) allows interventions to improve perinatal outcomes. A fasting plasma glucose (FPG) level ≥5.1 mmol/L is 100% specific for a diagnosis of GDM. The International Association of Diabetes and Pregnancy Study Groups acknowledges that FPG <4.5 mmol/L is associated with a low probability of GDM. Objectives. The validity of selective screening based on the presence of risk factors was compared with the universal application of FPG ≥4.5 mmol/L to identify women with GDM. FPG ≥4.5 mmol/L or the presence of one or more risk factors was assumed to indicate an intermediate to high risk of GDM and therefore the need for an oral glucose tolerance test (OGTT). Methods. Consecutive black South African (SA) women were recruited to a 2-hour 75 g OGTT at 24 -28 weeks' gestation in an urban community health clinic. Of 969 women recruited, 666 underwent an OGTT, and of these 589 were eligible for analysis. The glucose oxidase laboratory method was used to measure plasma glucose concentrations. The World Health Organization GDM diagnostic criteria were applied. All participants underwent a risk factor assessment. The χ 2 test was used to determine associations between risk factors and a positive diagnosis of GDM. The sensitivity and specificity of a positive diagnosis of GDM were calculated for FPG ≥4.5 mmol/L, FPG ≥5.1 mmol/L, and the presence of one or more risk factors. Results. The prevalence of overt diabetes mellitus and GDM was 0.5% and 7.0%, respectively. Risk factor-based selective screening indicated that 204/589 (34.6%) of participants needed an OGTT, but 18/41 (43.9%) of positive GDM diagnoses were missed. Universal screening using the FPG threshold of ≥4.5 mmol/L indicated that 152/589 (25.8%) of participants needed an OGTT, and 1/41 (2.4%) of positive diagnoses were missed. An FPG of ≥5.1 mmol/L identified 36/41 (87.8%) of GDM-positive participants. The sensitivity and specificity of the presence of one or more risk factors were 56% and 67%, respectively. The sensitivity and specificity of FPG ≥4.5 mmol/L were 98% and 80%, respectively. Conclusions. Universal screening using FPG ≥4.5 mmol/L had greater sensitivity and specificity in identifying GDM-affected women and required fewer women to undergo a resource-intensive diagnostic OGTT than risk factor-based selective screening. A universal screening strategy using FPG ≥4.5 mmol/L may be more efficient and cost-effective than risk factor-based selective screening for GDM in black SA women.

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Gestational Diabetes Mellitus: Using the Fasting Plasma Glucose Level to Simplify the International Association of Diabetes and Pregnancy Study Groups Diagnostic Algorithm in an Adult South Asian Population

Cited by 16 publications

References 15 publications

Continuous Glucose Monitoring in Women with Normal OGTT in Pregnancy

Continuous Glucose Monitoring in Women with Normal OGTT in Pregnancy

Glycated haemoglobin in the first trimester: A predictor of gestational diabetes mellitus in pregnant Asian Indian women

Fasting plasma glucose and risk factor assessment: Comparing sensitivity and specificity in identifying gestational diabetes in urban black African women

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