Improved gestational diabetes screening protocol

Abstract

Objectives This work aimed to assess the diagnostic validity of two approaches for the screening of gestational diabetes mellitus (GDM) with less discomfort for pregnant women. Methods A prospective diagnostic validation study was conducted with 2007 pregnant women. According to risk factors for GDM, women were classified into high-risk and low-risk groups. The current diagnostic procedure, based on oral glucose overload, was followed; simultaneously HbA1c was tested and an algorithm combining both biomarkers was applied. Results In the low-risk group, the Glucose challenge test (GCT) showed a higher area under the curve (AUC 0.953; 95% CI 0.915–0.992) than the HbA1c test (0.688; 95% CI 0.541–0.834). The best GCT cut-off, 153.5 mg/dL (8.52 mmol/L), showed higher diagnostic validity than that for HbA1c, 28 mmol/mol (4.75%), and that the algorithm using both tests. In the high-risk group, the GCT showed better diagnostic performance than the HbA1c and the algorithm; the optimal GCT cut-offs were higher than those recommended in current protocols. 13th week: GCT AUC 0.882 (95% CI 0.843–0.921), HbA1c AUC 0.624 (95% CI 0.562–0.686), GCT cut-off 140.5 mg/dL (7.8 mmol/L), HbA1c cut-off 33 mmol/mol (5.15%). 24th week: GCT AUC 0.944 (95% CI 0.925–0.962), HbA1c AUC 0.642 (95% CI 0.575–0.709), GCT cut-off, 145.5 mg/dL (8.08 mmol/L), HbA1c cut-off 29 mmol/mol (4.85%). Conclusions The GDM diagnostic approach using as the first step the GCT with higher cut-offs showed the best diagnostic validity. Applying these thresholds, 55.6 and 13.7% of 100 g. Oral glucose overloads would have been avoided in low-risk and high-risk pregnant women.

Back to basics: likelihood ratios for olive and grass pollen specific IgE in seasonal allergic rhinitis

“…The reporting of sIgE sensitization in vitro test results using a Bayesian approach has recently gained interest. In contrast to the dichotomy of a single, often arbitrary cut-off point, the use of LRs helps to determine to what extent a test result changes the probability of a particular diagnosis or treatment indication ( 32 , 42 – 45 ). Hence, the present study could help allergists in clinical decision-making.…”

Emerging biomarkers in gestational diabetes: perspectives for improving diagnosis and prognoses

“…Diagrama PRISMA del protocolo usado en la revisión bibliográfica Luego de una revisión exhaustiva de distintos artículos tomando en cuenta los criterios de inclusión y exclusión se mencionan los resultados más relevantes de acuerdo con investigaciones recientes de los biomarcadores para un diagnóstico temprano de DMG (Ver tabla 1). (20) 2020 Protocolo mejorado de detección de diabetes gestacional…”

“…El método del Test de O'Sullivan para el cribado de DMG es el que mostro una mejor validez de diagnóstico de acuerdo a los puntos de corte establecidos. (20) Johnny Se analizó la muestra de 170 mujeres en estado de gestación de 6 centros de salud con pruebas de O'Sullivan positivas con una mediana de edad de 35 años. De acuerdo con los criterios diagnósticos utilizados se obtuvo los siguientes resultados: Grupo Español de Diabetes y Embarazo GEDE/O'Sullivan p < 0,001; GEDE/ Carpenter p < 0,001; además los modelos de regresión binaria (RLB) con tres y cuatro variables tienen igual capacidad de diagnóstico cuando se utilizan los criterios de GEDE área bajo la curva ROC = 0,96, IC 95 %: 0,93-0,98.…”