Abnormal Glucose Tolerance Test Value Research Articles

Dietary Intake and Oral Glucose Tolerance Test Results in Women with Gestational Diabetes

Background/Objective: Diet is a risk factor for gestational diabetes mellitus (GDM). There are few studies on women’s diet and glucose tolerance test (GTT) results during pregnancy. The objective of this study was to evaluate the relationship between one’s previous diet and the number of abnormal values on the diagnostic GTT in women with GDM. We hypothesized that there would be an inverse relation between antioxidant micronutrient consumption and the number of abnormal GTT values. Methods: This cross-sectional study included 60 women diagnosed with GDM (2-h, 75 g-GTT), divided in two groups as follows: 1 abnormal glucose value and 2–3 abnormal values. Shortly after the diagnosis, participants answered a validated food frequency questionnaire to assess their food consumption in the last 6 months. The Mann–Whitney test was used to compare the dietary intake of the participants in the two groups. Results: The participant characteristics were similar. The median intake of total calories, carbohydrates, lipids, and proteins did not differ significantly between groups. Participants with 1 abnormal GTT value had significantly higher intakes of fiber (11.9 vs. 11.0 g/day p = 0.049), vitamin D (40.6 vs. 40.4 mcg/day p = 0.049), and vitamin C (180.0 vs. 151.0 mg/day p = 0.008) than those with 2–3 abnormal values. Conclusions: Our results suggest a possible association between the consumption of fiber and antioxidant micronutrients and the number of abnormal GTT values.

Do Differences Exist Between Groups With Varying Numbers of Abnormal Values on the Glucose Tolerance Test? [15L

INTRODUCTION: To determine whether patients with one abnormal value on the glucose tolerance test (GTT) have different outcomes compared to patients with varying numbers of abnormal values. METHODS: We conducted a retrospective chart review of women undergoing a glucose challenge test (GCT) followed by a GTT from July 2010-July 2015. Patients with pre-gestational diabetes were excluded. Primary outcomes were infant birth weight and mode of delivery. Secondary outcomes included shoulder dystocia, NICU admission, and development of preeclampsia. Data was analyzed via multivariable regression models. RESULTS: 5,913 charts were reviewed. 5,124 patients had a normal GCT. 499 had an abnormal GCT and zero abnormal values on the GTT (Group 0). 147 had one abnormal value on the GTT (Group 1), and 143 had two or more abnormal values on the GTT (Group 2). After controlling for maternal age, infant sex, and gestational age, group 0 had a significant increase in rate of cesarean delivery, birth weight, NICU admission, shoulder dystocia and preeclampsia compared to patients with a normal GCT. Group 1 had a significant increase in rate of cesarean delivery, birth weight, NICU admission and preeclampsia when compared to group 0. No significant differences in outcomes existed between group 1 and group 2, the treated gestational diabetics. CONCLUSION: Glucose intolerance is a spectrum with an increasing number of abnormal GTT values leading to an increased likelihood of poor outcomes. Patients with an abnormal GCT should be counseled on potential maternal and neonatal morbidities and the potential to modify outcomes with treatment.

Risk of Adverse Perinatal Outcomes in African American Women With One Elevated 3-Hour Oral Glucose Tolerance Test Value [329

INTRODUCTION: The importance of screening for gestational diabetes has been well studied; however, the significance of one abnormal value in a 3-hour glucose tolerance test remains controversial. The objective was to examine whether African American women with one abnormal glucose tolerance test value are at increased risk for adverse perinatal outcomes compared with women who screened negative. METHODS: A retrospective chart review was performed assessing singleton pregnancies in African American women between January and August 2014 at State University of New York Downstate Medical Center. Perinatal outcomes measured included: cord pH, Apgar scores, birth weights, and delivery mode. Exclusion criteria included multiple gestation, pregestational diabetes mellitus, maternal comorbidities including hypertension, autoimmune disease, cancer, morbid obesity, hypercholesterolemia, hypertriglyceridemia, heart disease, lung disease, and renal failure diagnosed before pregnancy. Fisher's exact test was used with a P value of <.05 indicating statistical significance. RESULTS: Of 386 patients, 56 had one elevated glucose tolerance test value and 330 were in the comparison group. Women with one elevated glucose tolerance test value had a higher rates of cesarean delivery (P<.01), birth weight greater than 4,000 g (P<.001), and greater than 4,500 g (P<.05). There were no significant differences in 5-minute Apgar scores (P<.30) or cord pH (P<.22). CONCLUSION: In the African American population served by this institution, it appears that although women with one positive glucose tolerance test value do not meet strict criteria for a diagnosis of gestational diabetes, they are still at risk for higher rates of operative delivery and fetal birth weights.

Gestational Glucose Tolerance and Maternal Metabolic Profile at 3 Years Postpartum

To estimate the independent effect of gestational impaired glucose tolerance, defined as a single abnormal oral glucose tolerance test value, on metabolic dysfunction at 3 years postpartum. We used multiple linear regression to measure associations between glucose testing during pregnancy and metabolic markers at 3 years postpartum in Project Viva, a prospective cohort study of maternal and infant health. We compared metabolic measures at 3 years postpartum among four groups: normal glucose challenge test (less than 140 mg/dL, n=461); abnormal glucose challenge test but normal glucose tolerance test (n=39); impaired glucose tolerance (a single abnormal glucose tolerance test value, n=21); and gestational diabetes mellitus (n=16). Adjusting for age, race, parity, parental history of diabetes, and maternal body mass index at 3 years postpartum, we found women with gestational diabetes mellitus had lower adiponectin (11.2 ng/mL compared with 20.7 ng/mL) and higher homeostatic model assessments of insulin resistance (3.1 compared with 1.3) and waist circumference (91.3 cm compared with 86.2 cm) compared with women with impaired glucose tolerance or normal glucose tolerance. Women in both the impaired glucose tolerance and gestational diabetes mellitus groups had lower high-density lipoprotein (gestational diabetes mellitus 44.7 mg/dL; impaired glucose tolerance 45.4/dL compared with normal glucose tolerance 55.8 mg/dL) and higher triglycerides (gestational diabetes mellitus 136.1 mg/dL; impaired glucose tolerance 140.1 mg/dL compared with normal glucose tolerance 78.3) compared with women in the normal glucose tolerance group. We found the highest values for hemoglobin A1c (gestational diabetes mellitus 5.1%, impaired glucose tolerance 5.3%, normal glucose tolerance 5.1%) and high-sensitivity C-reactive protein (gestational diabetes mellitus 1.4 mg/dL, impaired glucose tolerance 2.2 mg/dL, normal glucose tolerance 1.0 mg/dL) among women with impaired glucose tolerance. Gestational diabetes mellitus and impaired glucose tolerance during pregnancy are associated with persistent metabolic dysfunction at 3 years postpartum, independent of other clinical risk factors.

Positive association between a single abnormal glucose tolerance test value in pregnancy and subsequent abnormal glucose tolerance

To study the prevalence of abnormal glucose tolerance among women with a single abnormal glucose tolerance test value in previous pregnancy and identify factors predictive of the later development of abnormal glucose tolerance in this group. In all, 58 women with gestational diabetes, 66 with a single abnormal value in a glucose tolerance test, and 56 control women underwent a 75-g oral glucose tolerance test at a mean of 6.9 years from the index pregnancy. Abnormal glucose tolerance was present in 34.5% of women with previous gestational diabetes and in 28.7% of women with 1 previous abnormal value, significantly different from the controls (9.7%). Independent risk factors that distinguished the subjects who later developed an abnormal glucose tolerance were prepregnancy BMI, parity > 1, and first-degree relatives affected by diabetes mellitus in the group with gestational diabetes, and prepregnancy BMI, maternal age, (> or = 30 y) and parity > 1 in the group with a single abnormal value. Prepregnancy BMI (> or = 26.9) proved to be the most predictive factor of abnormal glucose tolerance later in life. Sicilian women with a single abnormal value at the glucose tolerance test in pregnancy have an increased likelihood of developing an abnormal glucose tolerance later in life, similar to gestational diabetes. Prepregnancy BMI was confirmed as the strongest predictive factor in both groups.

Determinants of Fetal Growth at Different Periods of Pregnancies Complicated by Gestational Diabetes or Impaired Glucose Tolerance

Eliminating macrosomia is a key goal when treating pregnant women with gestational diabetes mellitus (GDM). Previous studies have focused on risk factors for macrosomia at the time of birth. The present retrospective study had as its goal to identify those maternal parameters that most strongly affect fetal growth at different phases of pregnancy. The study population included 280 women with singleton pregnancies and GDM, defined as 2 or more abnormal glucose tolerance test (GTT) values, and 88 others with impaired glucose tolerance (IGT) as evidenced by a single abnormal GTT value. The 2 groups were managed in similar ways with individualized diabetic diets, caloric restriction when obese, and daily self-monitoring of blood glucose values. Fetal macrosomia was defined as an abdominal circumference (AC) at the 90th percentile or higher. At least 85% of women in both groups had a fasting glucose no higher than 95 mg/dl throughout the study period and mean daily glucose levels less than 100 mg/dl. Fetal macrosomia was diagnosed at entry to the study in 18.5% of women, paralleling the 17.6% rate of large-for-gestational age (LGA) infants (birth weigh at the 90th percentile or higher). Women whose fetuses were macrosomic were significantly more likely to have had a previous LGA pregnancy; to be of higher parity; to have a higher body mass index (BMI); and to give birth to an LGA infant. A past LGA infant independently predicted fetal macrosomia at entry, with an odds ratio (OR) of 3.6. The same was true for a prepregnancy body mass index of 30 kg/m 2 or higher (OR, 2.1). No predictors were evident before 24 weeks' gestation. A history of an LGA infant became predictive at this time, accompanied by obesity at 28 weeks. Elevated fasting glucose was a significant predictor at 32 and 36 weeks' gestation. Both a previous LGA infant and obesity independently predicted LGA at birth. The major factors influencing fetal growth in the late second and early third trimesters appear to be the maternal BMI and a LGA infant in a past pregnancy. Closer to term, maternal glycemia is the predominant factor. Targeting different parameters at different stages of pregnancy could effectively lower the risk of having an LGA infant in obese women with GDM or impaired glucose tolerance.

Determinants of fetal growth at different periods of pregnancies complicated by gestational diabetes mellitus or impaired glucose tolerance.

To determine maternal parameters with the strongest influence on fetal growth in different periods of pregnancies complicated by an abnormal glucose tolerance test (GTT). Retrospective study of 368 women with gestational diabetes mellitus (GDM; > or = 2 abnormal GTT values, n = 280) and impaired glucose tolerance (IGT; one abnormal value, n = 88) with 869 ultrasound examinations at entry to and during diabetic care. Both groups were managed comparably. Abdominal circumference (AC) > or = 90th percentile defined fetal macrosomia. Maternal historical and clinical parameters, and diagnostic and glycemic values of glucose profiles divided into five categories of 4 weeks of gestational age (GA; <24 weeks, 24 weeks/0 days to 27 weeks/6 days, 28/0-31/6, 32/0-35/6, and 36/0-40/0 [referred to as <24 GA, 24 GA, 28 GA, 32 GA, and 36 GA categories, respectively]) were tested by univariate and multiple logistic regression analysis for their ability to predict an AC > or = 90th percentile at each GA group and large-for-gestational-age (LGA) newborn. Data obtained at entry were also analyzed separately irrespective of the GA. Maternal weight, glycemia after therapy, rates of fetal macrosomia, and LGA were not significantly different between GDM and IGT; thus, both groups were analyzed together. LGA in a previous pregnancy, (odds ratio [OR] 3.6; 95% CI 1.8-7.3) and prepregnancy obesity (BMI > or = 30 kg/m(2); 2.1; 1.2-3.7) independently predicted AC > or = 90th percentile at entry. When data for each GA category were analyzed, no predictors were found for <24 GA. Independent predictors for each subsequent GA category were as follows: at 24 GA, LGA history (OR 9.8); at 28 GA, LGA history (OR 4.2), and obesity (OR 3.3); at 32 GA, fasting glucose of 32 GA (OR 1.6 per 5-mg/dl increase); at 36 GA, fasting glucose of 32 GA (OR 1.6); and for LGA at birth, LGA history (OR 2.7), and obesity (OR 2.4). In the late second and early third trimester, maternal BMI and LGA in a previous pregnancy appear to have the strongest influence on fetal growth, while later in the third trimester coincident with the period of maximum growth described in diabetic pregnancies, maternal glycemia predominates.

The number of abnormal plasma glucose values in the oral glucose tolerance test and the feto-maternal outcome of pregnancy

Objective: With respect to the feto-maternal outcome of pregnancy both appropriate screening and treatment of gestational diabetes mellitus (GDM) remain a matter of debate. Furthermore, the importance of only one abnormal glucose value at the glucose tolerance test (GTT) is still discussed, including the term “gestational impaired glucose tolerance” with normal fasting but an increased 2 h postprandial glucose value. Study design: We have evaluated the feto-maternal outcome of pregnancy in 152 women with abnormal glucose values during the oral 100 g GTT. The data were analysed with respect to the number of abnormal GTT values and compared to age- and body mass index (BMI)-matched control groups including 304 women with normal GTT values. Results: A positive family history of diabetes was found in 24.4% of the GDM women and in 16.4% of the control group. In 45.9% of the women with abnormal GTT values glucose target levels could be obtained by dietary management, 54.1% required additional insulin therapy. Insulin therapy was administered in 32.8% of the women with one abnormal GTT value, in 65.0% of the women with two abnormal values and in 83.3% of the women with three abnormal values. Compared to the age- and BMI-matched control group the percentage of women with hypertension was increased in women with one, two and three abnormal GTT values. The percentage of LGA and macrosomic infants was significantly increased only in women with three abnormal GTT values. Women with one, two or three abnormal GTT values revealed an increased percentage of caesarean section compared to the control group. Conclusions: Our results show that women with three abnormal GTT values are at an overall increased risk with respect to the feto-maternal outcome of pregnancy. Compared to the control group also women with only one abnormal GTT value revealed an increased risk indicating a need for further control and therapy.

Does insulin secretion in patients with one abnormal glucose tolerance test value mimic gestational diabetes mellitus?

Objective: The purpose of this study was to investigate the insulin response to a 3-hour oral glucose tolerance test and to compare the insulin levels in the gestational diabetes mellitus and single abnormal test value groups with a nondiabetic control group. Study Design: One hundred ten Turkish women with uncomplicated pregnancy participated in this prospective controlled study between 24 to 28 weeks of gestation. A 100-g 3-hour oral glucose tolerance test was given, and glucose and insulin plasma levels were assayed. The subjects were classified according to established criteria. Early-phase insulin secretion was assessed by the insulinogenic index. Total insulin secretion was assessed by mean insulin level during the oral glucose tolerance test; insulin resistance was assessed by fasting insulin concentration and by the use of the homeostasis model. Data were analyzed by the Student t test and 1-way analysis of variance, with posthoc Bonferroni correction. Results: The fasting insulin levels of patients with normal oral glucose tolerance test results were significantly lower than those of patients with gestational diabetes mellitus and a single value abnormality (P <.001 and P <.005, respectively). The insulinogenic index as a marker of early-phase insulin secretion was significantly lower in gestational diabetes mellitus, compared with that of patients with normal oral glucose tolerance test results (P <.05). The worsening of glycemic profile from normal oral glucose tolerance test results to gestational diabetes mellitus was associated with an increase in the homeostasis model; no significant difference was found between gestational diabetes mellitus and a single value abnormality group in terms of both the homeostasis model and the insulinogenic index. Values for total insulin secretion were highest in gestational diabetes mellitus, followed by the single value abnormality group, both significantly differing from the values of patients with normal oral glucose tolerance test results (P <.001 and P <.005, respectively). Conclusion: In this prospective study of Turkish subjects, we found a striking similarity in terms of patient characteristics between the gestational diabetes mellitus group and the single value abnormality group. Additionally, when we used fasting insulin level and insulin resistance as 2 separate criteria of analysis, patients with single value abnormality were indistinguishable from patients with gestational diabetes mellitus; both groups were significantly different from the normal oral glucose tolerance test group. Our findings suggest that a single abnormal test value on an oral glucose tolerance test should be regarded as a pathologic finding and that the patient with a single abnormal test value may be treated similarly to the patient with gestational diabetes mellitus. (Am J Obstet Gynecol 2002;186:204-9.)

Glucose tolerance test during pregnancy: The significance of one abnormal value

To determine the perinatal impacts of one abnormal oral glucose tolerance test (GTT) value, we conducted a retrospective study of pregnancy outcome in our population. Pregnant women (4314) were screened for gestational diabetes (GDM) between 24 and 32 weeks with the 50-g glucose challenge test and 183 were directly tested with the 100-g GTT. The subjects who had a serum glucose value equal or greater than 7.8 mmol/L 1 h after a 50-g glucose challenge were scheduled for a 100-g GTT (904). Another 32 subjects, who were not screened, were found to have gestational diabetes identified by repeated fasting and postprandial serum glucose measurements. Retrospectively, the study population was divided in four groups: I, normal (4138); II, GDM (237); III, subjects with one abnormal GTT value treated like GDM (85); IV, subjects with one abnormal GTT value untreated (69). Patient characteristics of groups II, III, and IV were similar. The area under the glycemic curve was similar between groups III and IV and was statistically inferior to that of Group II. GTT periodicity was the greatest in group II. Group II showed a higher rate of delivery before 37 weeks, of chronic and pregnancy induced hypertension, and of cesarian section but groups III and IV were not statistically different from group I. Percentages of macrosomic infants were comparable for the four groups; incidence of neonatal hypoglycemia was similar in groups I, III, and IV and it was significantly increased in group II (21%); other parameters such as icterus, respiratory distress syndrome, tachypnea, fractures, or death were not statistically different between the groups except for hypocalcemia that was increased in group II ( p < 0.01). These results lead us to conclude that in our population of pregnant women who had ready access to a pregnancy follow-up program, one abnormal GTT value has no measurable negative impacts on perinatal outcome and therefore does not necessitate specific treatment different from that of normal subjects.

Does one abnormal glucose tolerance test value increase adverse outcome in pregnancy?

Living according to one׳s personal values has implications for wellbeing, and incongruence between personal and workplace values has been associated with burnout. Using the SGP Card Sorting Task (Ciarrochi & Bailey, 2008), this study explored mental health practitioners׳ personal life values and personal work-related values, and their relationships with wellbeing and burnout. Congruence between life and work-related values was related to wellbeing and perceived accomplishment at work. Those whose personal values were consistent with the commonly-shared values of a caring profession experienced lower burnout and higher personal wellbeing. Successfully pursuing one׳s work values predicted lower burnout and greater wellbeing. Honesty, clearly defined work, competence and meeting obligations were associated with lower burnout and higher wellbeing. Acceptance of others and helping others were associated with lower burnout. The implications for recovery-oriented practice are noted. Values clarification exercises may invigorate the sense of meaning in practitioners׳ work, increasing wellbeing and reducing staff burnout.

The significance of one abnormal glucose tolerance test value on adverse outcome in pregnancy

A matched control study of 126 women equally divided into three groups (normal oral glucose tolerance test, one abnormal test value, and gestational diabetes mellitus) was undertaken to examine the relationships among oral glucose tolerance test results, glycemic control in pregnancy, and adverse perinatal outcome. Characterization of metabolic control for the one abnormal oral glucose tolerance test value and the gestational diabetes mellitus groups (before treatment) showed no significant difference. After the start of treatment, however, a significant (p less than 0.01) difference between the groups in level of control was found. While no significant difference in the average birth weight between the three groups was discovered, the incidence of large infants (macrosomia and large for gestational age) was found to be significantly higher in the one abnormal oral glucose tolerance test group when compared with the normal (34% versus 9%; p less than 0.01) and gestational diabetes mellitus group (34% versus 12%; p less than 0.01). No significant difference for the incidence of an infant large for gestational age was found between the normal group and the patients with gestational diabetes mellitus after treatment. Neonatal metabolic disorders were found to be significantly higher for the one abnormal oral glucose tolerance test group (15%) when compared with the control and the gestational diabetes mellitus groups (3%). We conclude that, if left untreated, one abnormal value on an oral glucose tolerance test is strongly associated with adverse perinatal outcome.

The significance of one abnormal glucose tolerance test value on adverse outcome in pregnancy

A matched control study of 126 women equally divided into three groups (normal oral glucose tolerance test, one abnormal test value, and gestational diabetes mellitus) was undertaken to examine the relationships among oral glucose tolerance test results, glycemic control in pregnancy, and adverse perinatal outcome. Characterization of metabolic control for the one abnormal oral glucose tolerance test value and the gestational diabetes mellitus groups (before treatment) showed no significant difference. After the start of treatment, however, a significant (p less than 0.01) difference between the groups in level of control was found. While no significant difference in the average birth weight between the three groups was discovered, the incidence of large infants (macrosomia and large for gestational age) was found to be significantly higher in the one abnormal oral glucose tolerance test group when compared with the normal (34% versus 9%; p less than 0.01) and gestational diabetes mellitus group (34% versus 12%; p less than 0.01). No significant difference for the incidence of an infant large for gestational age was found between the normal group and the patients with gestational diabetes mellitus after treatment. Neonatal metabolic disorders were found to be significantly higher for the one abnormal oral glucose tolerance test group (15%) when compared with the control and the gestational diabetes mellitus groups (3%). We conclude that, if left untreated, one abnormal value on an oral glucose tolerance test is strongly associated with adverse perinatal outcome.