• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Glucose Tolerance Test Alternatives During the COVID-19 Pandemic (and Beyond)?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Oral glucose tolerance tests can be challenging during the COVID-19 pandemic due to social distancing restrictions
    • National guidelines for many countries recommend alternative options for hyperglycemia screening
  • Meek et al. (Diabetic Medicine, 2020) evaluated the diagnostic and prognostic performance of oral glucose tolerance tests alternatives

METHODS:

  • Retrospective study
  • Data sources
    • Cambridge University Hospital NHS Foundation Trust (CUHFT) data
    • OPHELIA prospective observational study, UK
  • Participants
    • From CUHFT: Singleton pregnancies with GDM
    • From OPHELIA: Women with ≥1 GDM risk factor
  • Study design
    • Receiver-operating characteristic (ROC) curves and unadjusted logistic regression were used to compare
      • Random plasma glucose
      • Fasting plasma glucose
      • HbA1c performance
  • Primary outcomes
    • Gestational diabetes (NICE or International Association of Diabetes and Pregnancy Study [IADPS] Groups criteria)
    • Diabetes in pregnancy (WHO criteria)
    • Cesarean delivery
    • LGA
    • Neonatal hypoglycemia
    • NICU admission

RESULTS:

  • In CUHFT: 17,736 singleton pregnancies | 826 GDM pregnancies
  • In OPHELIA: 361 women with ≥1 GDM risk factor
  • GDM diagnosis was significantly associated with
    • Random plasma glucose at 12 weeks
      • AUROC (NICE and IADPS) 0.81 (95% CI, 0.79 to 0.83)
    • Fasting plasma glucose
      • AUROC (NICE): 0.75 (95% CI, 0.65 to 0.85)
      • AUROC (IADPS): 0.92 (95% CI, 0.85 to 0.98)
    • HbA1c at 28 weeks’ gestation
      • AUROC (NICE): 0.83 (95% CI, 0.75 to 0.90)
      • AUROC (IADPS): 0.84 (95% CI, 0.77 to 0.91)
  • For a 5% GDM detection rate (similar to detection rate using standard oral glucose testing) the following cut-offs would be required
    • At 12 weeks: Random plasma glucose ≥8.5 mmol/l (153 mg/dL | Sensitivity 42%; Specificity 96%
    • At 28 weeks
      • HbA1c ≥39 mmol/mol (5.7%) | Sensitivity 26%; Specificity 96%
      • Fasting plasma glucose ≥5.2–5.4 mmol/l (93.6 mg/dL to 97.2 mg/dL) | Sensitivity 18–41%; Specificity 97–98%
  • These measures predicted some of the pregnancy outcomes

CONCLUSION:

  • The following alternative testing strategies can identify pregnant women with hyperglycemia at risk of adverse pregnancy outcomes vs oral glucose testing
    • Random plasma glucose at 12 weeks
    • Fasting plasma glucose
    • HbA1c at 28 weeks
  • The authors state that while all 3 approaches can predict obstetric and neonatal outcomes, practice should not be changed post-pandemic without further research and long term data

Learn More – Primary Sources:

Approaches to screening for hyperglycaemia in pregnant women during and after the COVID‐19 pandemic

SOCIETY FOR BIOMEDICAL DIABETES RESEARCH: Conversion of HbA1c values from % to mmol/mol

Get COVID-19 Research Summaries Direct to Your Phone, with ObGFirst

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Does Treating Hyperglycemia Earlier in Pregnancy Improve Neonatal and Maternal Outcomes?
One Step or Two Step: Which is the Best Method for GDM Screening?
Can Glucose Screening in Pregnancy Predict Future Risk of Cardiovascular Disease in non-GDM Women?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site