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

Viswanathan Mohan,Kumar Maheswari,Ranjit Unnikrishnan,Ram Uma,Manni Mohanraj Mahalakshmi,Ranjit Mohan Anjana,Mohan Deepa,Sriram Usha,Balaji Bhavadharini,Sonak D Pastakia,Arivudainambi Kayal,Gunasekaran Kalaiyarasi,Belma Malanda,Anne Belton

doi:10.1007/s00592-014-0660-5

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.

Highlights

Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of any severity, first recognized during pregnancy [1]
The Diabetes in Pregnancy Study Group of India (DIPSI) has laid down guidelines for diagnosis of gestational diabetes mellitus (GDM) and proposes that the oral glucose tolerance test (OGTT) can be performed in a non-fasting state
The DIPSI guidelines further suggest that a nonfasting OGTT using a 2-h venous plasma glucose (VPG) value of 140 mg/dl (7.8 mmol/l) can be used as a single-step, definitive, screening and diagnostic test for GDM

Summary

Introduction

Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of any severity, first recognized during pregnancy [1]. The prevalence of GDM varies widely based on the diagnostic criteria used and the ethnic group studied [2]. There is no international consensus on the screening and diagnostic criteria for GDM. In 1999, the World Health Organization (WHO) introduced criteria for diagnosis of GDM on the basis of a 2-h venous plasma glucose (VPG) cut-off value of 140 mg/dl (7.8 mmol/l), after the administration of 75 g of glucose [3]. In 2010, based on the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) proposed a new set of criteria which has since been adopted in many countries [5, 6]. The WHO has adopted the IADPSG criteria [7]

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