Abstract
Global prevalence increase of diabetes type 2 and gestational diabetes (GDM) has led to increased awareness and screening of pregnant women for GDM. Ideally screening for GDM should be done by an oral glucose tolerance test (oGTT), which is laborious and time consuming. A randomized glucose test incorporated with anthropomorphic characteristics may be an appropriate cost-effective combined clinical and biochemical screening protocol for clinical practice as well as cutting down on oGTTs. A retrospective observational study was performed on a randomized sample of pregnant women who required an OGTT during their pregnancy. Biochemical and anthropomorphic data along with obstetric outcomes were statistically analyzed. Backward stepwise logistic regression and receiver operating characteristics curves were used to obtain a suitable predictor for GDM without an oGTT and formulate a screening protocol. Significant GDM predictive variables were fasting blood glucose (p = 0.0001) and random blood glucose (p = 0.012). Different RBG and FBG cutoff points with anthropomorphic characteristics were compared to carbohydrate metabolic status to diagnose GDM without oGTT, leading to a screening protocol. A screening protocol incorporating IADPSG diagnostic criteria, BMI, and different RBG and FBG criteria would help predict GDM among high-risk populations earlier and reduce the need for oGTT test.
Highlights
In Europe, type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT) are on the increase, with 56 million individuals reportedly suffering from T2DM and 60.6 million having IGT [1, 2]
The gestational diabetes mellitus (GDM) subgroup had significantly elevated mean random blood glucoses (RBG) values compared to their normal glycemic tolerance (NGT) counterparts (5.4 ± 1.5 mmol/L versus 4.7 ± 0.9 mmol/L: p = 0.0001), as well as elevated mean fasting blood glucose (FBG) values (5.0 ± 1.1 mmol/L versus 4.3 ± 0.4 mmol/L: p = 0.0001)
RBG was an inferior predictor test when compared to FBG
Summary
In Europe, type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT) are on the increase, with 56 million individuals reportedly suffering from T2DM and 60.6 million having IGT [1, 2]. The apparent rising rates of T2DM/IGT and obesity are expected to contribute to a concomitant rise in GDM prevalence rates [3, 4]. The International Diabetes Federation (IDF) reported that, in 2013, an estimate of 10.9% of pregnancies in Europe suffered from gestational diabetes mellitus (GDM) [2]. The Mediterranean population is susceptible to both T2DM and obesity and has a concomitant relatively high prevalence of GDM [5, 6]. The GDM prevalence rate in this population has been estimated in 2010 to be 16.5% of the whole pregnant population using the newly proposed International Association of Diabetes and Pregnancy Study Group (IADPSG) diagnostic criteria [4, 5]. The high prevalence of obesity and diabetes mellitus in the Maltese population has been linked to intrauterine nutritional environment adverse effects and to genetic influences [6, 7]
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