Managed by Massimo Porta.
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.
A 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.
Of 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 %).
The 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.
International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium: International Diabetes Federation, 2013. http://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf. Accessed on 25 July 2014
Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15:539–553
Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. (2002) American Diabetes Association: clinical practice recommendations 2002. Diabetes Care 25(Suppl 1):S1–S147
International Association of Diabetes and Pregnancy Study Groups (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33:676–682 CrossRef
Coustan DR, Lowe LP, Metzger BE, Dyer AR, International Association of Diabetes and Pregnancy Study Groups (2010) The hyperglycemia and adverse pregnancy outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus. Am J Obstet Gynecol 202(654):e1–e6
Diagnostic criteria and classification of hyperglycemia first detected in pregnancy. World Health Organization 2013, p.63; WHO/NMH/MND/13.2 http://apps.who.int/iris/bitstream/10665/85975/1/WHO_NMH_MND_13.2_eng.pdf. Accessed on 25 July 2014
http://www.idf.org/women-india-gdm-strategy-wings. Accessed on 25 July 2014
Seshiah V, Sahay BK, Das AK, Shah S, Banerjee S, Rao PV, Ammini A, Balaji V, Gupta S, Divakar H, Misra S, Thanawala U (2009) Gestational diabetes mellitus—Indian guidelines. J Indian Med Assoc 107(799–802):804–806
Government of India, Ministry of Health and Family Welfare, Nirman Bhavan, New Delhi (DO No. M-12015/93/2011-MCH/2011). Accessed on 25 July 2014
Seshiah V, Das AK, Balaji V, Joshi SR, Parikh MN, Gupta S (2006) Diabetes in pregnancy study group. Gestational diabetes mellitus—guidelines. J Assoc Physicians India 54:622–688 PubMed
Reyes-Muñoz E, Parra A, Castillo-Mora A, Ortega-González C (2012) Effect of the diagnostic criteria of the international association of diabetes and pregnancy study groups on the prevalence of gestational diabetes mellitus in urban Mexican women: a cross-sectional study. Endocr Pract 18:146–151 PubMedCrossRef
Zhu WW, Fan L, Yang HX, Kong LY, Su SP, Wang ZL, Hu YL, Zhang MH, Sun LZ, Mi Y, Du XP, Zhang H, Wang YH, Huang YP, Zhong LR, Wu HR, Li N, Wang YF, Kapur A (2013) Fasting plasma glucose at 24–28 weeks to screen for gestational diabetes mellitus: new evidence from China. Diabetes Care 36:2038–2040 PubMedCentralPubMedCrossRef
- Comparison of screening for gestational diabetes mellitus by oral glucose tolerance tests done in the non-fasting (random) and fasting states
Manni Mohanraj Mahalakshmi
Ranjit Mohan Anjana
Sonak D. Pastakia
- Springer Milan
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II