Philippine CPG on Diagnosis & Screening for Gestational Diabetes
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Philippine CPG on Diagnosis & Screening for Gestational Diabetes

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Philippine CPG on diagnosis and screening of gestational diabetes presented for comments at the 3rd Unite for Diabetes Annual Convention this September.

Philippine CPG on diagnosis and screening of gestational diabetes presented for comments at the 3rd Unite for Diabetes Annual Convention this September.

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Philippine CPG on Diagnosis & Screening for Gestational Diabetes Philippine CPG on Diagnosis & Screening for Gestational Diabetes Presentation Transcript

  • UNITE FOR DIABETES CPG Screening and Diagnosis of Diabetes in Pregnant Women Iris Thiele Isip Tan MD, FPCP, FPSEM Clinical Associate Professor UP College of Medicine Section of Endocrinology, Diabetes & Metabolism Department of Medicine, Philippine General Hospital
  • 6.1 Should universal screening for diabetes be done among pregnant women? Recommendation: All pregnant women should be screened for gestational diabetes (Level 2, Grade B).
  • 6.1 Should universal screening for diabetes be done among pregnant women? National GDM Technical Working Party of N. Zealand DIPSI Universal Universal screening screening high GDM ADA prevalence NICE Very low risk* in India Women with women need any risk factor not be should be screened screened
  • 6.1 All pregnant women should be screened for gestational diabetes (Level 2, Grade B). Filipino women are at increased risk for diabetes in pregnancy. ASGODIP Data n/N Low risk 35/853 High risk 136/350 171/1203 Overall 14.2% Litonjua AD et al. AFES Study Group on Diabetes in Pregnancy: Preliminary Data on Prevalence. PJIM 1996:34:67-68.
  • 6.1 All pregnant women should be screened for gestational diabetes (Level 2, Grade B). RR for developing gestational diabetes by ethnicity (adjusted for age, BMI and parity; white as reference) UK Data (1992) RR (95%CI) Black 3.1 (1.8 to 5.5) South East Asian 7.6 (4.1 to 14.1) Indian 11.3 (6.8 to 18.8) Dornhorst A, Paterson CM, Nicholls JSD, et al. High prevalence of gestational diabetes in women from ethnic minority groups. Diabetic Medicine 1992; 9:820–5.
  • 6.1 All pregnant women should be screened for gestational diabetes (Level 2, Grade B). Macrosomia Shoulder Dystocia Increased risk of perinatal morbidity Birth injuries Hypoglycemia http://www.flickr.com/photos/mikewade/3267336862/ http://www.flickr.com/photos/jessicafm/280232106/ http://www.flickr.com/photos/clairity/1385780317/ http://www.flickr.com/photos/tessawatson/379265818/
  • 6.1 All pregnant women should be screened for gestational diabetes (Level 2, Grade B). Treatment reduces perinatal ACHOIS morbidity Landon et al Crowther et al. NEJM 2009; NEJM 2005; 361:1339-48. 352:2477-86.
  • ACHOIS Crowther et al. NEJM 2005; M 352:2477-86. O Randomized controlled I Serious trial perinatal P Intervention complications (n=490) death diet CBG insulin shoulder dystocia vs bone fracture nerve palsy routine care (n=510) GDM 24-28 wks AOG Crowther CA et al. Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes. NEJM 2005; 352:2477-86.
  • Any serious perinatal complication ACHOIS Adj RR 0.33 (95% CI 0.14-0.75), p=0.01 Crowther et al. NEJM 2005; M 352:2477-86. O Randomized controlled I Serious trial perinatal P Intervention complications (n=490) death diet CBG insulin shoulder dystocia vs bone fracture nerve palsy routine care (n=510) GDM 24-28 wks AOG Crowther CA et al. Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes. NEJM 2005; 352:2477-86.
  • Landon et al NEJM 2009; M 361:1339-48. O Randomized Composite of controlled I stillbirth/ trial perinatal P Intervention death and (n=485) neonatal diet CBG insulin complications vs hyperbilirubinemia routine care hypoglycemia (n=473) hyperinsulinemia birth trauma “mild” GDM 24-31 wks AOG Landon MB et al. A multicenter, randomized trial of treatment for mild gestational diabetes. NEJM 2009; 361:1339-48.
  • Composite endpoint RR 0.87 (95% CI 0.72-1.07), p=0.14 Landon et al NEJM 2009; M 361:1339-48. O Randomized Composite of controlled I stillbirth/ trial perinatal P Intervention death and (n=485) neonatal diet CBG insulin complications vs hyperbilirubinemia routine care hypoglycemia (n=473) hyperinsulinemia birth trauma “mild” GDM 24-31 wks AOG Landon MB et al. A multicenter, randomized trial of treatment for mild gestational diabetes. NEJM 2009; 361:1339-48.
  • Composite endpoint RR 0.87 (95% CI 0.72-1.07), p=0.14 Landon et al NEJM 2009; M 361:1339-48. O Randomized controlled I trial P Intervention (n=485) diet CBG insulin vs routine care (n=473) “mild” GDM 24-31 wks AOG Landon MB et al. A multicenter, randomized trial of treatment for mild gestational diabetes. NEJM 2009; 361:1339-48.
  • Composite endpoint RR 0.87 (95% CI 0.72-1.07), p=0.14 Landon et al NEJM 2009; M 361:1339-48. O Randomized LGA infants controlled I RR 0.49 trial P Intervention (95%CI 0.32-0.76) p<0.001 (n=485) diet CBG insulin BW >4000 g vs RR 0.41 routine care (95%CI 0.26-0.66) (n=473) p<0.001 “mild” GDM 24-31 wks AOG Landon MB et al. A multicenter, randomized trial of treatment for mild gestational diabetes. NEJM 2009; 361:1339-48.
  • 6.1 All pregnant women should be screened for gestational diabetes (Level 2, Grade B). Cesearean Section Preeclampsia Increased risk of maternal morbidity Pregnancy-induced hypertension Type 2 diabetes mellitus http://www.flickr.com/photos/j2dread/4501366303/ http://www.flickr.com/photos/ulybug/512369383/ http://www.flickr.com/photos/78428166@N00/4921825364/
  • 6.1 All pregnant women should be screened for gestational diabetes (Level 2, Grade B). Treatment reduces maternal morbidity Landon et al Ratner et al NEJM 2009; JCEM 2008; 361:1339-48 93:4774-9
  • Landon et al NEJM 2009; M 361:1339-48. O Randomized Composite of controlled I stillbirth/ trial perinatal P Intervention death and (n=485) neonatal diet CBG insulin complications vs hyperbilirubinemia routine care hypoglycemia (n=473) hyperinsulinemia birth trauma “mild” GDM 24-31 wks AOG Landon MB et al. A multicenter, randomized trial of treatment for mild gestational diabetes. NEJM 2009; 361:1339-48.
  • Landon et al NEJM 2009; 361:1339-48. Preeclampsia Cesarean Preeclampsia or gestational delivery RR 0.46 hypertension RR 0.79 (0.22-0.97) RR 0.63 (0.64-0.99) p=0.02 (0.42-0.96) p=0.02 p=0.01 Landon MB et al. A multicenter, randomized trial of treatment for mild gestational diabetes. NEJM 2009; 361:1339-48.
  • Ratner et al JCEM 2008; M 93:4774-9 O Randomized controlled I Time to trial development P DPP arms of diabetes placebo metformin semiannual FPG intensive lifestyle annual OGTT Women in DPP 350 with previous GDM 1416 without Ratner RE et al. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. JCEM 2008;93: 4774-9
  • 4778 Ratner et al. Diabetes in Women with a History of GDM J Clin Endocrinol Metab, December 2008, 93(12):4774 – 4779 Cumulative incidence of diabetes in DPP (%) A 45 40 Without a history of GDM 35 Cumulative incidence (%) 30 Placebo 25 Placebo (n=487) 20 15 Metformin Metformin ILS (n=464) 10 ILS 5 (n=465) 0 0 0.5 1 1.5 2 2.5 3 Years from randomization B 45 40 With a history of GDM Placebo } Placebo ~50% 35 (n=122) 30 Cumulative incidence (%) 25 reduction 20 Metformin (n=111) Metformin 15 10 ILS (n=117) ILS 5 0 0 0.5 1 1.5 2 2.5 3 Years from randomization FIG. 4. Cumulative incidence of diabetes in DPP by randomized treatment group. Panel A, Women without a history of GDM; Panel B, women with a history of GDM. Ratner RE et al. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin 54% Caucasian. In interventions. JCEM 2008;93: 4774-9 We estimate that metformin therapy, on the other hand, whereas DPP was ethnically mixed with and lifestyle may be as much as 3 times more effective in reducing the the DPP, the GDM population was older (43 vs. 34 yr) and incidence of diabetes in those with a history of GDM com- considerably more distant from their index pregnancies (12
  • 6.2 For pregnant women, when should screening be done? Recommendations: 1. All pregnant women should be evaluated at the first prenatal visit for risk factors for diabetes (Level 4, Grade C).
  • All pregnant women should be evaluated at 6.2 the first prenatal visit for risk factors for diabetes (Level 4, Grade C). National GDM Technical Working Party of N. Zealand Screen high risk USPSTF women at No RCTs on booking screening before 24 NICE ADA weeks AOG Determine risk Screen high risk women at factors for GDM at booking first prenatal appointment visit http://www.flickr.com/photos/fdecomite/406635986/
  • Bartha et al. Am J Obstet Gynecol 2000; M 182:346-50. O Cross- Early- (n=65) vs sectional I late-onset comparative P 50-g GCT (n=170) GDM 1st visit then pregnancy 24-28 weeks complications, if initial result obstetric and normal perinatal (n=3986) outcomes Pregnant at first prenatal visit Bartha JL et al. Gestational Diabetes Mellitus Diagnosed During Early Pregnancy. Am J Obstet Gynecol 2000; 182:346-50.
  • Women with an early diagnosis of Bartha et al. GDM represent a high-risk subgroup Am J Obstet Gynecol 2000; M 182:346-50. O Cross- Early- (n=65) vs sectional I late-onset comparative P 50-g GCT (n=170) GDM 1st visit then pregnancy 24-28 weeks complications, if initial result obstetric and normal perinatal (n=3986) outcomes Pregnant at first prenatal visit Bartha JL et al. Gestational Diabetes Mellitus Diagnosed During Early Pregnancy. Am J Obstet Gynecol 2000; 182:346-50.
  • Women with an early diagnosis of Bartha et al. GDM represent a high-risk subgroup Am J Obstet Gynecol 2000; M 182:346-50. O Cross- sectional Early- vs late- comparative I onset GDM P 50-g GCT 1st visit then 24-28 weeks if initial result normal (n=3986) Pregnant at first prenatal visit Bartha JL et al. Gestational Diabetes Mellitus Diagnosed During Early Pregnancy. Am J Obstet Gynecol 2000; 182:346-50.
  • Women with an early diagnosis of Bartha et al. GDM represent a high-risk subgroup Am J Obstet Gynecol 2000; M 182:346-50. O Cross- sectional Early- vs late- comparative I onset GDM P 50-g GCT 1st visit then Likely Higher need 24-28 weeks hypertensive for insulin (18.46% vs (33.85% vs if initial result 5.88%, 7.06%, normal p=0.006) p=0.0000) (n=3986) Pregnant at first prenatal visit Bartha JL et al. Gestational Diabetes Mellitus Diagnosed During Early Pregnancy. Am J Obstet Gynecol 2000; 182:346-50.
  • Risk Factors for Gestational Diabetes Prior history of GDM (OR 23.6 [95%CI 11.6, 48.0])3 Glucosuria (OR 9.04 [95%CI 2.6, 63.7]2; PPV 50% 4) Family history of diabetes (OR 7.1 [95%CI 5.6, 8.9]1; OR 2.74 [95%CI 1.47, 5.11]3) First-degree relative with type 2 diabetes (PPV 6.7%)4 First-degree relative with type 1 diabetes (PPV 15%)4 Prior macrosomic baby (OR 5.59 [95%CI 2.68, 11.7])3 Age >25 years old (OR 1.9 [95%CI 1.3, 2.7]1; OR 3.37 [95%CI 1.45, 7.85]3) 1 Davey RX, Hamblin PS. Selective versus universal screening for gestational diabetes mellitus: an evaluation of predictive risk factors. Medical Journal of Australia 2001;174(3):118–21. 2 Schytte T, Jorgensen LG, Brandslund I, et al. The clinical impact of screening for gestational diabetes. Clinical Chemistry and Laboratory Medicine 2004;42(9):1036–42. 3 Ostlund I, Hanson U. Occurrence of gestational diabetes mellitus and the value of different screening indicators for the oral glucose tolerance test. Acta Obstetricia et Gynecologica Scandinavica 2003;82(2):103–8. 4 Griffin ME, Coffey M, Johnson H, et al. Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome. Diabetic Medicine 2000;17(1):26–32.
  • Risk Factors for Gestational Diabetes Diagnosis of polycystic ovary syndrome (OR 2.89 [95%CI 1.68, 4.98])5 Overweight or obese before pregnancy (BMI >27 kg/m2 OR 2.3 [95%CI 1.6, 3.3]1; BMI>30 kg/m2 OR 2.65 [95%CI 1.36, 5.14]3 Macrosomia in current pregnancy (PPV 40% 4) Polyhydramnios in current pregancy (PPV 40% 4) Intake of drugs affecting carbohydrate metabolism 1 Davey RX, Hamblin PS. Selective versus universal screening for gestational diabetes mellitus: an evaluation of predictive risk factors. Medical Journal of Australia 2001;174(3):118–21. 3 Ostlund I, Hanson U. Occurrence of gestational diabetes mellitus and the value of different screening indicators for the oral glucose tolerance test. Acta Obstetricia et Gynecologica Scandinavica 2003;82(2):103–8. 4 Griffin ME, Coffey M, Johnson H, et al. Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome. Diabetic Medicine 2000;17(1):26–32. 5 Toulis KA, Goulis DG, Kolibiankis EM, Venetis CA, et al. Risk of gestational diabetes mellitus in women with polycystic ovary syndrome: a systematic review and a meta-analysis. Fertil Steril 2009;92(2):667–77.
  • 6.2 For pregnant women, when should screening be done? Recommendations: 2. High-risk women should be tested at the soonest possible time (Level 3, Grade B).
  • High-risk women should be tested at the 6.2 soonest possible time (Level 3, Grade B). ADA Screen very high risk women DIPSI at first prenatal Screen early visit “... fetal beta cell recognizes and NICE responds... as early Offer SMBG or as 16th week of OGTT at 16-18 gestation.” wks AOG to women with previous GDM
  • 6.2 For pregnant women, when should screening be done? Recommendations: 3. Routine testing for gestational diabetes is recommended at 24-28 weeks age of gestation for women with no risk factors (Level 3, Grade B).
  • Routine testing for gestational diabetes is 6.2 recommended at 24-28 weeks age of gestation (Level 3, Grade B). ADA Test “greater than low risk women” for GDM at 24-28 ACHOIS wks AOG Treatment of GDM after 24 wks USPSTF AOG reduces complications NICE No evidence that screening after Offer OGTT at 24 the 24th week to 28 wks AOG to leads to reduction women with other in morbidity & risk factors mortality
  • 6.2 For pregnant women, when should screening be done? Recommendations: 4. Testing for gestational diabetes should still be carried out in women at risk, even beyond 24 to 28 weeks age of gestation (Level 3, Grade C).
  • Testing for gestational diabetes should still be 6.2 carried out in women at risk, even beyond 24 to 28 weeks age of gestation (Level 3, Grade C). Positive OGTT <26 weeks AOG >26 weeks AOG 15/295 20/558 Low risk 5.1% 3.6% 43/120 93/230 High risk 35.8% 40.4% Litonjua AD et al. AFES Study Group on Diabetes in Pregnancy: Preliminary Data on Prevalence. PJIM 1996:34:67-68.
  • Testing for gestational diabetes should still be 6.2 carried out in women at risk, even beyond 24 to 28 weeks age of gestation (Level 3, Grade C). 3 macrosomic ASGODIP Higher babies Cardinal Santos morbidity Medical Center rate (33%) 1 infant with >75% in those multiple diagnosed congenital evaluated GDM from anomalies after 26th 26 to 38 and Down’s wk AOG wks AOG syndrome Sy RAG et al. Viewpoints on Gestational Diabetes: Report from ASGODIP Participating Hospital: Cardinal Santos Medical Center. PJIM 1996;34:45-48
  • Testing for gestational diabetes should still be 6.2 carried out in women at risk, even beyond 24 to 28 weeks age of gestation (Level 3, Grade C). ASGODIP (Veterans Memorial Medical Center) AOG tested % <20 weeks 21-30 weeks 31-40 weeks n=19 n = 74 n = 60 Negative 95 92 85 for GDM Positive 5 8 15 for GDM Bihasa MTG et al. Screening for gestational diabetes: Report from ASGODIP participating hospital: Veterans Memorial Medical Center. PJIM 1996:34:57-61.
  • 6.3 Which tests should be used to screen pregnant women for gestational diabetes? Recommendation: An oral glucose tolerance test (OGTT), preferably the 75-g OGTT, should be used to screen for gestational diabetes (Level 3, Grade B).
  • An oral glucose tolerance test (OGTT), preferably 6.3 the 75-g OGTT, should be used to screen for gestational diabetes (Level 3, Grade B). IASDPG Initial visit DIPSI FPG, A1c or RPG 75-g OGTT at 75-g OGTT ADA 24-28 wks One-step OGTT or ASGODIP two-step 50-g GCT with GCT NICE if low-risk 75-g OGTT 75-g OGTT if high-risk
  • Should we still do the 50-g glucose challenge test (GCT)? fair Positive likelihood ratio: The increase in the odds of having the disease after a positive test result Qualitative LR (+) LR (-) LR(+) 4.34 Strength 95%CI(1.53,12.26) Excellent 10 0.1 Very Good 6 0.2 NICE LR(-) 0.42 95%CI(0.33,0.55) Fair 2 0.5 does not Useless 1 1 recommend 50-g GCT 4 studies n=2437 National Institute for Health and Clinical Excellence. Diabetes in pregnancy: management of diabetes & its complications from pre-conception to the postnatal period. March 2008 (reissued July 2008)
  • Should we still do the 50-g glucose challenge test (GCT)? Positive Predictive value The probability that a patient with a fair positive test result will have the disease (+) OGTT (-) OGTT Total (+) GCT 91 113 204 (-) GCT Not done 477 Positive Total 681 Predictive Value (PPV) 44.6% Carlos-Raboca J et al. JAFES 2002;20:19-24
  • Should we still do the 50-g glucose challenge test (GCT)? Significantly affected by the time of the last More likely to meal be positive if conducted in the afternoon Only moderately reproducible http://www.flickr.com/photos/neeta_lind/3572379176/
  • Should we still do the 50-g glucose challenge test (GCT)? ASGODIP Veterans Memorial 17.8%1 FEU-NRMFH 48%2 PGH (unpublished) after (+) GCT 36% 10 to 23% of after (+) GCT women fail to return for OGTT 1 De Asis TP et al. Incidence of gestational diabetes mellitus at after an initial Veterans Memorial Medical Center PJIM 1996; 34:63-66 GCT 2 Chua-Ho C et al. Screening for gestational diabetes mellitus: Report from ASGODIP Participating Hospital FEU-NRMFH PJIM 1996; 34:43-44 http://www.flickr.com/photos/daquellamanera/4552683663/
  • 75-g or 100-g OGTT? 100-g OGTT high glucose load often unpalatable 100-g OGTT duration 75-g OGTT 100-g more 3 hours international cumbersome; standard in 4 blood non-pregnant samples
  • 75-g or 100-g OGTT? Head-to- head studies Pettitt et al Deerochanawong Diabetes Care et al Diabetologia 1994; 17(11): 1996;39:1070-3 1264-8
  • Pettitt et al Diabetes Care 1994; 17(11): M 1264-8 O Cross- sectional I Macrosomia comparative P WHO 75-g Cesarean OGTT section vs NDDG 100-g OGTT Pregnant Pima Indian women (n=127) Pettitt DJ et al. Comparison of WHO and NDDG procedures to detect abnormalities of glucose tolerance during pregnancy. Diabetes Care 1994;17(11): 1264-8
  • Pettitt et al Diabetes Care 1994; 17(11): M Cross- 1264-8 O sectional comparative I P WHO 75-g OGTT vs NDDG 100-g OGTT Pregnant Pima Indian women (n=127) Pettitt DJ et al. Comparison of WHO and NDDG procedures to detect abnormalities of glucose tolerance during pregnancy. Diabetes Care 1994;17(11): 1264-8
  • Pettitt et al Diabetes Care 1994; 17(11): M Cross- 1264-8 O sectional Macrosomia comparative I 6/16 (38%) Cesarean P WHO 75-g had (+) 75g section OGTT OGTT 4/7 (57%) vs 1/16 (6%) had (+) 75g had (+) 100 g OGTT NDDG OGTT No one had (+) 100-g OGTT 100g OGTT Pregnant Pima Indian women (n=127) Pettitt DJ et al. Comparison of WHO and NDDG procedures to detect abnormalities of glucose tolerance during pregnancy. Diabetes Care 1994;17(11): 1264-8
  • Deerochanawong et al Diabetologia M 1996;39:1070-3 O Cross- sectional I Diagnosed comparative P WHO 75-g GDM OGTT Macrosomia vs NDDG 100-g OGTT Pregnant 24-28 wks AOG (n=709) Deerochanawong et al. Comparison of NDDG and WHO criteria for detecting gestational diabetes. Diabetologia 1996;39: 1070-3
  • Deerochanawong et al Diabetologia M 1996;39:1070-3 O Cross- sectional Diagnosed comparative I GDM P WHO 75-g 75-g OGTT OGTT 15.7% (111/709) vs 100-g OGTT NDDG 1.4% 100-g OGTT (10/709) Pregnant 24-28 wks AOG (n=709) Deerochanawong et al. Comparison of NDDG and WHO criteria for detecting gestational diabetes. Diabetologia 1996;39: 1070-3
  • Deerochanawong et al Diabetologia M 1996;39:1070-3 O Cross- sectional Diagnosed comparative I GDM P WHO 75-g 75-g OGTT Macrosomia OGTT 15.7% (111/709) 6/14 (43%) vs (+)75g OGTT 100-g OGTT NDDG 1.4% 3/14 (21%) 100-g OGTT (10/709) (+)100 g OGTT Pregnant 24-28 wks AOG (n=709) Deerochanawong et al. Comparison of NDDG and WHO criteria for detecting gestational diabetes. Diabetologia 1996;39: 1070-3
  • 6.4 What criteria will be used to interpret the 75-g OGTT? Recommendation: The criteria put forth by the International Association of Diabetes & Pregnancy Study Groups (IADPSG) will be used to interpret the 75-g OGTT (Level 3, Grade B). International Association of Diabetes and Pregnancy Study Groups Consensus Panel. IADPSG Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care 2010; 33(3):676-82.
  • Interpreting the 75-g OGTT Threshold(s) for diagnosing gestational diabetes (mg/dL) 75-g OGTT ASGODIP IADPSG* ADA** & DIPSI FBS 92 95 - 1-hour 180 180 - 2-hour 153 155 140 *Any one value meeting threshold is considered gestational diabetes. ** Two values must meet thresholds to be considered gestational diabetes
  • 6.5 What other tests can be used to screen pregnant women for diabetes? Recommendation: The following tests should not be used for the diagnosis of diabetes in pregnancy (Level 5, Grade D): Capillary blood glucose FBS* RBS* HbA1c Fructosamine Urine glucose Do an OGTT for those with glucosuria, elevated CBG or HbA1c. * If available at consultation, use same diagnostic threshold for diabetes as in non-pregnant
  • CBG should not be used for the diagnosis 6.5 of diabetes in pregnancy (Level 5,Grade D). Postprandial CBG higher than venous Validity of blood CBG vs OGTT Different Sensitivity unproven glucometers 47-87% used in Specificity studies 51-100%
  • FBS should not be used for the diagnosis 6.5 of diabetes in pregnancy (Level 5,Grade D). Paucity of data regarding reproducibility FBS varies with advancing gestation Agardh C- D . Åberg A , Nordén N . Glucose levels and insulin secretion during a 75 g glucose challenge test in normal pregnancy. J Intern Med 1996 ; 240 : 303–9. Lind T , Billewicz WZ , Brown G . A serial study of changes occurring in the oral glucose tolerance test in pregnancy J Obstet Gynaecol Br Com 1973 ; 80 : 1033–9 . Kühl C . Glucose metabolism during and after pregnancy in normal and gestational diabetic women . Acta Endocrinol 1975 ; 79 : 709–19.
  • RBS should not be used for the diagnosis 6.5 of diabetes in pregnancy (Level 5,Grade D). RBS 6.5 mmol/L (117 mg/dL) Sensitivity 75% No optimal Specificity 78% threshold for RBS indicating an OGTT Only 2 studies: RBS vs OGTT Jowett NI , Samanta AK , Burden AC . Screening for diabetes in pregnancy: Is a random blood glucose enough? Diabet Med 1987;4:160–3 Östlund I , Hanson U . Repeated random blood glucose measurements as universal screening test for gestational diabetes mellitus . Acta Obstet Gynecol Scand 2004;83:46–51
  • A1c should not be used for the diagnosis 6.5 of diabetes in pregnancy (Level 5,Grade D). HbA1c values did not differ between normal women and HbA1c in those with normal women GDM varies with ethnicity and gestation Loke DFM . Glycosylated haemoglobins in women with low risk for diabetes in pregnancy . Singapore Med J 1998;36:501–4 Agarwal M , Dhatt GS , Punnose J , Koster G . Gestational diabetes: a reappraisal of HBA1c as a screening test . Acta Obstet Gynecol Scand 2005;84:1159–63
  • 6.5 Fructosamine should not be used for the diagnosis of diabetes in pregnancy (Level 5,Grade D). Fructosamine did not differ between normal women and Fructosamine those with varies with GDM ethnicity and albumin levels Bor MV , Bor P , Cevik C . Serum fructosamine and fructosamine - albumen ratio as screening tests for gestational diabetes mellitus . Gynecol Obstet 1999; 262:105–11 Huter O , Heinz D , Brezinka C , Soelder E , Koelle D , Patsch JR . Low sensitivity of serum fructosamine as a screening parameter for gestational diabetes mellitus . Gynecol Obstet Invest 1992;34:20–3 Cefalu WT , Prather KL , Chester DL , Wheeler CJ , Biswas M , Pernoll MI . Total serum glycated proteins in detection and monitoring of gestational diabetes . Diabetes Care 1990;13:872–5
  • Urine glucose should not be used for the 6.5 diagnosis of diabetes in pregnancy (Level 5,Grade D). High ascorbic acid intake can cause Glucosuria glucosuria trace glucose 75 to >250 mg/dL Sensitivity False-positive 7-36% glucosuria Specificity with high levels of urinary ketones 83-98% (starvation ketosis)
  • Comments/suggestions welcome unitefordiabetes2010@gmail.com Thank You http://www.endocrine-witch.info