RCT Results: Does Fasting Impact the Rate of GDM Screen Positive Results?
BACKGROUND AND PURPOSE:
There is some evidence to suggest that the time between last meal and the 1-hour oral glucose tolerance test (OGTT) may impact the probability of a positive screening result
Sperling et al. (Obstetrics & Gynecology, 2022) evaluate the effect of fasting prior to the 1-hour OGTT on gestational diabetes mellitus (GDM) screening results
Single-center, prospective randomized trial
Pregnant patients without pregestational diabetes
Fasting: Fasting for ≥6 hours prior to testing
Fed: Oral intake within 2 hours of the 50-g, 1-h OGTT
The 1-h OGTT was administered >24 weeks
Positive screen result: Defined as a serum glucose level of ≥140 mg/dL
Protocol adherence was assessed by a survey administered immediately after the OGTT
Planned enrollment of 100 participants in each group to detect absolute difference of ≥20 percentage points on screen-positive rate | Assuming two-sided α=0.05 and power=0.8
1-h OGTT screen-positive rate
Mean 1-h OGTT glucose values
Maternal and neonatal outcomes
Patient perception of the test
Fasting: 97 participants | Fed: 98 participants
Adherence to fasting: 97.9% | Adherence to fed: 91.8%
The screen-positive rate was significantly higher in the fasting than the fed group
The mean glucose value was also higher in the fasting group
Fasting: 127.7 mg/dL
Fed: 113.3 mg/dL
The incidence of GDM in the fasting group was non-significantly higher than the fed group
Patients were asked if given a choice between fasting or eating prior to screening
Preference to eat: 71.1%
Preference to fast: 28.9%
There were no significant differences in maternal or neonatal outcomes
Fasting for 6 hours prior to 1-hour OGTT administration had higher screen-positive rates and greater mean glucose levels than those who ate within 2 hours of test administration
The authors state
…previous studies have demonstrated an increase in glucagon production and a marked delay in insulin concentration followed by a large release of insulin after a prolonged fast that eventually returns to a normal metabolic state after a period of refeeding in individuals without diabetes and those with prediabetes
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.
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