Gestational diabetes diagnostic study of choice: Difference between revisions
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==Overview== | ==Overview== | ||
There are two main methods for diagnosing GDM. The '''One-step''' approach: 75-g Oral glucose tolerance test; and the '''Two-step''' approach with a 50-g (non-fasting) screen, followed by a 100-g OGTT for those who screen positive. Both methods can accurately diagnose GDM, but one-step strategy has been adopted internationally and has improved pregnancy outcomes with cost savings and may be the preferred method of diagnosing GDM. | There are two main methods for diagnosing GDM. The '''One-step''' approach: 75-g [[Glucose tolerance test|Oral glucose tolerance test]]; and the '''Two-step''' approach with a 50-g (non-fasting) screen, followed by a 100-g [[Glucose tolerance test|OGTT]] for those who screen positive. Both methods can accurately diagnose [[Gestational diabetes|GDM]], but one-step strategy has been adopted internationally and has improved pregnancy outcomes with cost savings and may be the preferred method of diagnosing GDM. | ||
==Diagnostic recommendations== | ==Diagnostic recommendations== | ||
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!style="background:#4479BA; color: #FFFFFF;" align="center" + |'''ADA Recommendation for diagnosis of gestational diabetes''' | ! style="background:#4479BA; color: #FFFFFF;" align="center" + |'''ADA Recommendation for diagnosis of gestational diabetes''' | ||
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* Test for undiagnosed diabetes at the first prenatal visit in those with risk factors, using standard diagnostic criteria. | * Test for undiagnosed diabetes at the first [[prenatal]] visit in those with risk factors, using standard diagnostic criteria. | ||
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* Test for gestational diabetes mellitus at 24–28 weeks of gestation in pregnant women not previously known to have diabetes. | * Test for gestational diabetes mellitus at 24–28 weeks of gestation in pregnant women not previously known to have [[diabetes]]. | ||
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* Test women with gestational diabetes mellitus for persistent diabetes at 4–12 weeks postpartum, using the oral glucose tolerance test and clinically appropriate nonpregnancy diagnostic criteria. | * Test women with gestational diabetes mellitus for persistent diabetes at 4–12 weeks [[postpartum]], using the [[Glucose tolerance test|oral glucose tolerance test]] and clinically appropriate nonpregnancy diagnostic criteria. | ||
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* Women with a history of gestational diabetes mellitus should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. | * Women with a history of gestational diabetes mellitus should have lifelong screening for the development of [[diabetes]] or [[prediabetes]] at least every 3 years. | ||
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* Women with a history of gestational diabetes mellitus found to have prediabetes should receive intensive lifestyle interventions or metformin to prevent diabetes. | * Women with a history of gestational diabetes mellitus found to have prediabetes should receive intensive lifestyle interventions or [[metformin]] to prevent diabetes. | ||
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!style="background:#DCDCDC; + " |<small>'''Adapted from [http://care.diabetesjournals.org/content/41/Supplement_1/S13.html#bx2| ADA]''' | ! style="background:#DCDCDC; + " |<small>'''Adapted from [http://care.diabetesjournals.org/content/41/Supplement_1/S13.html#bx2| ADA]''' | ||
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==Diagnostic criteria== | ==Diagnostic criteria== | ||
If the screening test for GDM is positive, the next step is to confirm the diagnosis. There are 2 strategies for confirming the diagnosis of GDM. | If the screening test for GDM is positive, the next step is to confirm the diagnosis. There are 2 strategies for confirming the diagnosis of GDM. | ||
*'''One-step approach:''' 75-g Oral glucose tolerance test (OGTT) | *'''One-step approach:''' 75-g [[Oral glucose tolerance test|Oral glucose tolerance test (OGTT)]] | ||
::::::'''OR''' | ::::::'''OR''' | ||
*'''Two-step''' '''approach''' with a 50-g (non fasting) ''screen,'' followed by a 100-g OGTT for those who screen positive.<ref name="pmid26807004">{{cite journal |vauthors= |title=Standards of Medical Care in Diabetes-2016 Abridged for Primary Care Providers |journal=Clin Diabetes |volume=34 |issue=1 |pages=3–21 |year=2016 |pmid=26807004 |doi=10.2337/diaclin.34.1.3 |url=}}</ref> | *'''Two-step''' '''approach''' with a 50-g (non fasting) ''screen,'' followed by a 100-g [[Glucose tolerance test|OGTT]] for those who screen positive.<ref name="pmid26807004">{{cite journal |vauthors= |title=Standards of Medical Care in Diabetes-2016 Abridged for Primary Care Providers |journal=Clin Diabetes |volume=34 |issue=1 |pages=3–21 |year=2016 |pmid=26807004 |doi=10.2337/diaclin.34.1.3 |url=}}</ref> | ||
===One-Step Strategy=== | ===One-Step Strategy=== | ||
Perform a 75 g glucose tolerance test in 24-28 weeks of pregnancy. Blood glucose level is measured | * Perform a 75 g [[glucose tolerance test]] in 24-28 weeks of pregnancy. | ||
The OGTT should be performed in the morning after an overnight fast of at least 8 h. | * Blood glucose level is measured 1h and 2 h after glucose ingestion, [[fasting blood glucose]] is measured prior to the ingestion of the 75g glucose load.<ref name="pmid26807004">{{cite journal |vauthors= |title=Standards of Medical Care in Diabetes-2016 Abridged for Primary Care Providers |journal=Clin Diabetes |volume=34 |issue=1 |pages=3–21 |year=2016 |pmid=26807004 |doi=10.2337/diaclin.34.1.3 |url=}}</ref> | ||
The diagnosis of GDM is made when any of the following plasma glucose values are met or exceeded: | * The [[Glucose tolerance test|OGTT]] should be performed in the morning after an overnight fast of at least 8 h. | ||
* Fasting: 92 mg/dL (5.1 mmol/L) | * The diagnosis of GDM is made when any of the following plasma glucose values are met or exceeded: | ||
* 1 h: 180 mg/dL (10.0 mmol/L) | |||
* 2 h: 153 mg/dL (8.5 mmol/L) | ** Fasting: 92 mg/dL (5.1 mmol/L) | ||
** 1 h: 180 mg/dL (10.0 mmol/L) | |||
** 2 h: 153 mg/dL (8.5 mmol/L) | |||
===Two-Step Strategy=== | ===Two-Step Strategy=== | ||
In this approach, screening is done 1 h after a 50-g glucose load test (GLT), followed by a 3 h 100-g OGTT for those who screen positive.<ref name="pmid26696673">{{cite journal |vauthors= |title=Professional Practice Committee for the Standards of Medical Care in Diabetes-2016 |journal=Diabetes Care |volume=39 Suppl 1 |issue= |pages=S107–8 |year=2016 |pmid=26696673 |doi=10.2337/dc16-S018 |url=}}</ref> | * In this approach, screening is done 1 h after a 50-g glucose load test (GLT), followed by a 3 h 100-g OGTT for those who screen positive.<ref name="pmid26696673">{{cite journal |vauthors= |title=Professional Practice Committee for the Standards of Medical Care in Diabetes-2016 |journal=Diabetes Care |volume=39 Suppl 1 |issue= |pages=S107–8 |year=2016 |pmid=26696673 |doi=10.2337/dc16-S018 |url=}}</ref> | ||
* The diagnosis of GDM is made when at least 2 out of 4 measurements of the 3 h 100-g OGTT is abnormal. | |||
The diagnosis of GDM is made when at least 2 out of 4 measurements of the 3 h 100-g OGTT is abnormal. | |||
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The following table summarizes the diagnostic approach for gestational diabetes. | The following table summarizes the diagnostic approach for gestational diabetes. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]
Overview
There are two main methods for diagnosing GDM. The One-step approach: 75-g Oral glucose tolerance test; and the Two-step approach with a 50-g (non-fasting) screen, followed by a 100-g OGTT for those who screen positive. Both methods can accurately diagnose GDM, but one-step strategy has been adopted internationally and has improved pregnancy outcomes with cost savings and may be the preferred method of diagnosing GDM.
Diagnostic recommendations
Following are the recommendations for the diagnostic test for gestational diabetes.[1]
| ADA Recommendation for diagnosis of gestational diabetes |
|---|
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| Adapted from ADA |
Diagnostic criteria
If the screening test for GDM is positive, the next step is to confirm the diagnosis. There are 2 strategies for confirming the diagnosis of GDM.
- One-step approach: 75-g Oral glucose tolerance test (OGTT)
- OR
- Two-step approach with a 50-g (non fasting) screen, followed by a 100-g OGTT for those who screen positive.[2]
One-Step Strategy
- Perform a 75 g glucose tolerance test in 24-28 weeks of pregnancy.
- Blood glucose level is measured 1h and 2 h after glucose ingestion, fasting blood glucose is measured prior to the ingestion of the 75g glucose load.[2]
- The OGTT should be performed in the morning after an overnight fast of at least 8 h.
- The diagnosis of GDM is made when any of the following plasma glucose values are met or exceeded:
- Fasting: 92 mg/dL (5.1 mmol/L)
- 1 h: 180 mg/dL (10.0 mmol/L)
- 2 h: 153 mg/dL (8.5 mmol/L)
Two-Step Strategy
- In this approach, screening is done 1 h after a 50-g glucose load test (GLT), followed by a 3 h 100-g OGTT for those who screen positive.[3]
- The diagnosis of GDM is made when at least 2 out of 4 measurements of the 3 h 100-g OGTT is abnormal.
The following table summarizes the diagnostic approach for gestational diabetes.
| Cut off (mg/dl) | ||||
|---|---|---|---|---|
| Fasting | 1 Hour | 2 Hour | 3 Hour | |
|
92 | 180 | 153 | ---- |
|
---- | 140 | ---- | ---- |
|
95 | 180 | 155 | 140 |
|
105 | 190 | 165 | 145 |
- The glucose values used for the detection of gestational diabetes were first determined by O'Sullivan and Mahan (1964) in a retrospective study designed to detect the risk of developing type II diabetes in the future. The values were set using whole blood. [6] Subsequent information has led to alterations in O'Sullivan's criteria. Following a change in the method for blood glucose evaluation from the use of whole blood to venous plasma samples, the criteria for GDM were also changed (whole blood glucose values have been shown to be lower than plasma glucose levels due to glucose uptake by hemoglobin).
- The diagnostic criteria from the National Diabetes Data Group (NDDG) have been used most often, but some centers rely on the Carpenter and Coustan criteria, which set the cutoff for normal glycemic status at lower values. Compared with the NDDG criteria, the Carpenter and Coustan criteria led to a diagnosis of gestational diabetes in 54 percent more pregnant women, with an increased cost and no compelling evidence of improved perinatal outcomes. [7]
References
- ↑ "2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2018". Diabetes Care. 41 (Supplement 1): S13–S27. 2017. doi:10.2337/dc18-S002. ISSN 0149-5992.
- ↑ 2.0 2.1 "Standards of Medical Care in Diabetes-2016 Abridged for Primary Care Providers". Clin Diabetes. 34 (1): 3–21. 2016. doi:10.2337/diaclin.34.1.3. PMID 26807004.
- ↑ "Professional Practice Committee for the Standards of Medical Care in Diabetes-2016". Diabetes Care. 39 Suppl 1: S107–8. 2016. doi:10.2337/dc16-S018. PMID 26696673.
- ↑ Carpenter MW, Coustan DR (1982). "Criteria for screening tests for gestational diabetes". Am. J. Obstet. Gynecol. 144 (7): 768–73. PMID 7148898.
- ↑ "Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group". Diabetes. 28 (12): 1039–57. 1979. PMID 510803.
- ↑ "Gestational Diabetes". Diabetes Mellitus & Pregnancy - Gestational Diabetes. Armenian Medical Network. 2006. Retrieved 2006-11-27. Text " Carla Janzen, MD, Jeffrey S. Greenspoon, MD " ignored (help)
- ↑ Carpenter MW, Coustan DR. (1982 Dec). "Criteria for screening tests for gestational diabetes.,". Am J Obstet Gynecol. (1, 144(7):768-73). Check date values in:
|year=(help); External link in|title=(help)