Self-Monitoring of Blood Glucose: A Complementary Method Beyond the Oral Glucose Tolerance Test to Identify Hyperglycemia During Pregnancy

Ardilouze, Amélie; Bouchard, Patricia; Hivert, Marie‐France; Simard, Catherine; Allard, Catherine; Garant, Marie-Pierre; Ménard, Julie; Ouellet, Annie; Houde, Ghislaine; Pesant, Marie-Hélène; Baillargeon, Jean-Patrice; Ardilouze, Jean-Luc

doi:10.1016/j.jcjd.2019.02.004

Cited by 15 publications

(17 citation statements)

References 34 publications

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“…to use FPG and HbA1c measurement with proposed thresholds as a substitute for OGTT. This proposal should all the more be temporary and other options might be considered [36,37]. As shown in our study, considering lower FPG [21,25,32] and HbA1c thresholds [22][23][24] would increase sensitivity.…”

Section: Discussionmentioning

confidence: 89%

“…For example, FPG thresholds of 4.4 mmol/L have been reported to rule out HIP in 50-65% of women with a sensitivity of 80-95% [19][20][21]. Also, as suggested in the case of a personal history of bariatric surgery [38], women could self-monitor their blood glucose at home but this implies education to do so [37]. Thus, there is an urgent need to validate new methods to diagnose and manage HIP in order to be ready to face future pandemics/lockdowns.…”

Section: Discussionmentioning

confidence: 99%

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COVID-19 pandemic: Can fasting plasma glucose and HbA1c replace the oral glucose tolerance test to screen for hyperglycaemia in pregnancy?

Nachtergaele

Vicaut

Pinto

et al. 2021

Diabetes Research and Clinical Practice

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To evaluate proposals considering HbA1c and fasting plasma glucose (FPG) measurement as a substitute for oral glucose tolerance test (OGTT) to diagnose hyperglycaemia in pregnancy (HIP) during COVID-19 pandemic. Methods: Of the 7,334 women who underwent the OGTT between 22 and 30 weeks gestation, 966 had HIP (WHO diagnostic criteria, reference standard). The 467 women who had an available HbA1c were used for analysis. French-speaking Society of Diabetes (SFD) proposal to diagnose HIP during COVID-19 pandemic was retrospectively applied: HbA1c 5.7% (39 mmol/mol) and/or FPG level 5.1 mmol/l. SFD proposal sensitivity for HIP diagnosis and the occurrence of HIP-related events (preeclampsia, large for gestational age infant, shoulder dystocia or neonatal hypoglycaemia) in women with false negative (FN) and true positive (TP) HIP-diagnoses were evaluated. Results: The sensitivity was 57% [95% confidence interval 52-62]. FN women had globally lower plasma glucose levels during OGTT, lower HbA1c and body mass index than those TP. The percentage of HIP-related events was similar in FN (who were cared) and TP cases,

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

COVID-19 pandemic: Can fasting plasma glucose and HbA1c replace the oral glucose tolerance test to screen for hyperglycaemia in pregnancy?

Nachtergaele

Vicaut

Pinto

et al. 2021

Diabetes Research and Clinical Practice

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“…A Canadian study found that almost 50% of women with GDM diagnosed using an OGTT were normoglycaemic using capillary glucose monitoring in daily life, emphasizing concerns about sensitivity 28 . Continuous glucose monitoring reflects fetal exposure to maternal glycaemia during the 24‐h day, providing substantially more detailed glucose measurements compared to an OGTT or capillary glucose monitoring.…”

Section: Discussionmentioning

confidence: 99%

“…24 A Canadian study found that almost 50% of women with GDM diagnosed using an OGTT were normoglycaemic using capillary glucose monitoring in daily life, emphasizing concerns about sensitivity. 28 Continuous glucose monitoring reflects fetal exposure to maternal glycaemia during the 24-h day, providing substantially more detailed glucose measurements compared to an OGTT or capillary glucose monitoring. Preliminary data have identified the continuous glucose monitoring glucose profiles associated with LGA infants in women with GDM, although further research is needed to determine the feasibility and performance of continuous glucose monitoring for GDM diagnosis.…”

Section: T a B L E 4 (Continued)mentioning

confidence: 99%

Approaches to screening for hyperglycaemia in pregnant women during and after the COVID‐19 pandemic

et al. 2020

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Aim To evaluate the diagnostic and prognostic performance of alternative diagnostic strategies to oral glucose tolerance tests, including random plasma glucose, fasting plasma glucose and HbA 1c , during the COVID‐19 pandemic. Methods Retrospective service data (Cambridge, UK; 17 736 consecutive singleton pregnancies, 2004–2008; 826 consecutive gestational diabetes pregnancies, 2014–2019) and 361 women with ≥1 gestational diabetes risk factor (OPHELIA prospective observational study, UK) were included. Pregnancy outcomes included gestational diabetes (National Institute of Health and Clinical Excellence or International Association of Diabetes and Pregnancy Study Groups criteria), diabetes in pregnancy (WHO criteria), Caesarean section, large‐for‐gestational age infant, neonatal hypoglycaemia and neonatal intensive care unit admission. Receiver‐operating characteristic curves and unadjusted logistic regression were used to compare random plasma glucose, fasting plasma glucose and HbA 1c performance. Results Gestational diabetes diagnosis was significantly associated with random plasma glucose at 12 weeks [area under the receiver‐operating characteristic curve for both criteria 0.81 (95% CI 0.79–0.83)], fasting plasma glucose [National Institute of Health and Clinical Excellence: area under the receiver‐operating characteristic curve 0.75 (95% CI 0.65–0.85); International Association of Diabetes and Pregnancy Study Groups: area under the receiver‐operating characteristic curve 0.92 (95% CI 0.85–0.98)] and HbA 1c at 28 weeks' gestation [National Institute of Health and Clinical Excellence: 0.83 (95% CI 0.75–0.90); International Association of Diabetes and Pregnancy Study Groups: 0.84 (95% CI 0.77–0.91)]. Each measure predicts some, but not all, pregnancy outcomes studied. At 12 weeks, ~5% of women would be identified using random plasma glucose ≥8.5 mmol/l (sensitivity 42%; specificity 96%) and at 28 weeks using HbA 1c ≥39 mmol/mol (sensitivity 26%; specificity 96%) or fasting plasma glucose ≥5.2–5.4 mmol/l (sensitivity 18–41%; specificity 97–98%). Conclusions Random plasma glucose at 12 weeks, and fasting plasma glucose or HbA 1c at 28 weeks identify women with hyperglycaemia at risk of suboptimal pregnancy outcomes. These opportunistic laboratory tests perform adequately for risk stratification when oral glucose tolerance testing is not available.

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“…Using a completely different approach to diagnosis, in this issue of the Journal, Ardilouze et al (11) compare use of the Canadian "preferred" approach to simply doing self blood glucose monitoring (fasting and 2-hour postprandial) for 7 days without modifying the maternal diet or lifestyle. GDM was diagnosed if at least 4 of 7 glucose values were out of the target range before breakfast or after any meal.…”

mentioning

confidence: 99%

Diagnosis of Gestational Diabetes: More Questions Than Answers

Feig

Keely

Wicklow

2019

Canadian Journal of Diabetes

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Self-Monitoring of Blood Glucose: A Complementary Method Beyond the Oral Glucose Tolerance Test to Identify Hyperglycemia During Pregnancy

Cited by 15 publications

References 34 publications

COVID-19 pandemic: Can fasting plasma glucose and HbA1c replace the oral glucose tolerance test to screen for hyperglycaemia in pregnancy?

COVID-19 pandemic: Can fasting plasma glucose and HbA1c replace the oral glucose tolerance test to screen for hyperglycaemia in pregnancy?

Approaches to screening for hyperglycaemia in pregnant women during and after the COVID‐19 pandemic

Diagnosis of Gestational Diabetes: More Questions Than Answers

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