Use of capillary blood glucose for screening for gestational diabetes mellitus in resource-constrained settings.

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

doi:10.1007/s00592-015-0761-9

Abstract

AimsThe aim of the study was to evaluate usefulness of capillary blood glucose (CBG) for diagnosis of gestational diabetes mellitus (GDM) in resource-constrained settings where venous plasma glucose (VPG) estimations may be impossible.MethodsConsecutive pregnant women (n = 1031) attending antenatal clinics in southern India underwent 75-g oral glucose tolerance test (OGTT). Fasting, 1- and 2-h VPG (AU2700 Beckman, Fullerton, CA) and CBG (One Touch Ultra-II, LifeScan) were simultaneously measured. Sensitivity and specificity were estimated for different CBG cut points using the International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria for the diagnosis of GDM as gold standard. Bland–Altman plots were drawn to look at the agreement between CBG and VPG. Correlation and regression equation analysis were also derived for CBG values.ResultsPearson’s correlation between VPG and CBG for fasting was r = 0.433 [intraclass correlation coefficient (ICC) = 0.596, p < 0.001], for 1H, it was r = 0.653 (ICC = 0.776, p < 0.001), and for 2H, r = 0.784 (ICC = 0.834, p < 0.001). Comparing a single CBG 2-h cut point of 140 mg/dl (7.8 mmol/l) with the IADPSG criteria, the sensitivity and specificity were 62.3 and 80.7 %, respectively. If CBG cut points of 120 mg/dl (6.6 mmol/l) or 110 mg/dl (6.1 mmol/l) were used, the sensitivity improves to 78.3 and 92.5 %, respectively. ConclusionsIn settings where VPG estimations are not possible, CBG can be used as an initial screening test for GDM, using lower 2H CBG cut points to maximize the sensitivity. Those who screen positive can be referred to higher centers for definitive testing, using VPG.Electronic supplementary materialThe online version of this article (doi:10.1007/s00592-015-0761-9) contains supplementary material, which is available to authorized users.

Highlights

The prevalence of gestational diabetes mellitus (GDM) is rapidly increasing and currently affects up to 15 % of pregnant women worldwide [1]
In settings where venous plasma glucose (VPG) estimations are not possible, capillary blood glucose (CBG) can be used as an initial screening test for GDM, using lower 2H CBG cut points to maximize the sensitivity
Those who screen positive can be referred to higher centers for definitive testing, using VPG

Summary

Introduction

The prevalence of gestational diabetes mellitus (GDM) is rapidly increasing and currently affects up to 15 % of pregnant women worldwide [1]. Acta Diabetol (2016) 53:91–97 the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study [4], the International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria were developed which recommends three venous plasma glucose samples, i.e., fasting, one and 2 h after administration of 75 g glucose [5]. In many resource-constrained settings in the developing world, obtaining venous samples may be difficult or impossible, due to shortage of trained phlebotomists and limited access to standardized laboratories. In such situations, if screening for GDM is to be done at all, the only alternative would be to use a handheld blood glucose meter to perform capillary blood glucose (CBG) testing. The use of CBG for diagnosis of GDM is not recommended. There are few studies comparing CBG with the old WHO 1999 criteria for GDM [6] but none, to our knowledge, have compared CBG with IADPSG criteria

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