Pregnant women's experience of undergoing an oral glucose tolerance test: A cross-sectional study

Continuous Glucose Monitoring-Measured Glucose Levels During Oral Glucose Tolerance Testing in Pregnancy

Background: To diagnose gestational diabetes mellitus (GDM), clinicians typically rely on the oral glucose tolerance test (OGTT). Continuous glucose monitoring (CGM) is a tool that could possibly be used to complement or replace the OGTT. Our aim is to describe CGM-derived glycemic patterns observed concurrently during the administration of a diagnostic OGTT in pregnancy. Methods: In total, 119 pregnant females underwent OGTT testing while wearing a blinded CGM sensor. Blood glucose (BG) measurements collected during the OGTT were compared with CGM-measured glucose values obtained using a Dexcom G6 Pro sensor to determine the differences between CGM-measured and BG levels during the OGTT, measure glycemic excursion during the OGTT, and determine differences in GDM diagnosis using standard BG draws during OGTT versus CGM-measured glucose levels. Results: CGM-measured glucose levels were on average higher than paired BG levels during the OGTT at each timed measurement (fasting, 1-, 2- and 3-h); fasting CGM-measured glucose levels in particular were higher than fasting BG levels by 6 ± 13 mg/dL. The median CGM minus BG-measured glycemic excursion during the OGTT was 12 and 4 mg/dL for the 75 g and 100 g OGTT, respectively. Of 28 participants diagnosed with GDM based on OGTT BG levels, 24 (86%) participants would have been diagnosed as GDM using CGM with BG-based thresholds; of 91 participants not diagnosed with GDM, 54 (59%) would also have not been diagnosed with GDM using CGM. Conclusions: CGM glucose measurements using Dexcom G6 Pro tended to be slightly higher than BG values during an OGTT, leading to more participants who would have been diagnosed with GDM if the BG-based OGTT thresholds were applied to these CGM-measured glucose values. When CGM is used for GDM diagnosis, diagnostic glucose criteria may need to be specific for the type of sensor used accounting for any bias in glucose measurement.

Plasma Glycated CD59 and Gestational Diabetes Mellitus: A Systematic Review

AIMS

Gestational diabetes mellitus (GDM) is a common complication of pregnancy worldwide. The standard method for screening GDM is the 75 g oral glucose tolerance test (OGTT). However, the OGTT is difficult, time-consuming and requires fasting, making it an inconvenient test for GDM. Researchers have turned their attention to alternative biomarkers for GDM. This study aimed to systematically investigate the potential of plasma glycated CD59 (pGCD59) as a new biomarker for GDM and its associated adverse pregnancy outcomes.

METHODS

The systematic review was performed in the PubMed, ISI Web of Science, Scopus and Google Scholar databases from 1/1/2000 to 4/1/2024, and relevant studies were selected based on the inclusion and exclusion criteria. The quality of the studies was assessed using the Newcastle-Ottawa scale.

RESULTS

The study revealed that pGCD59 levels before 20 weeks and during the second trimester of pregnancy have the potential to predict the results of the OGTT and also forecast adverse pregnancy outcomes, such as postpartum glucose intolerance (PP GI), neonatal hypoglycaemia (NH) and having large for gestational age (LGA) infants. The predictive ability of pGCD59 was found to be affected by the GDM status, especially body mass index (BMI).

CONCLUSIONS

In conclusion, pGCD59 may be a promising indicator of glucose levels and could serve as a new biomarker for GDM. However, additional studies are needed to establish a reliable reference range and cut-off value for pGCD59.

Gestational diabetes in Germany-prevalence, trend during the past decade and utilization of follow-up care: an observational study

Gestational diabetes mellitus (GDM) is one of the most common medical complications in pregnancy. Information on key figures such as screening rates, prevalence of GDM or utilization of follow-up care and associated factors varies widely and is often lacking. The aim of our study is to provide information on screening rates for and prevalence of GDM as well as utilization of follow-up care in Germany. We used data (2010-2020) from a large, nationwide statutory health insurance containing information on inpatient and outpatient care, including diagnoses, medication and treatments. Descriptive analyses were performed to assess screening rates, prevalence of GDM and participation rates in follow-up care. A log-binomial regression model was calculated to analyze associated factors. Screening rates among pregnant women increased from 40.2% (2010) to 93.3% (2020) and prevalence from 9.4% (2010) to 15.1% (2020). The proportion of women attending follow-up care remained stable over time (around 42%). Age, educational level, insulin prescription, hypertension and obesity were positively associated with participation in follow-up care. Although over 90% of women in Germany are screened for GDM during pregnancy, follow-up care is used much less. Further research is needed to understand the trends in GDM healthcare (from screening to follow-up care) and the reasons for women's (non-)participation, as well as the attitudes and routines of the healthcare providers involved.

Criteria for prediabetes and posttransplant diabetes mellitus after kidney transplantation: A 2-year diagnostic accuracy study of participants from a randomized controlled trial

Posttransplant diabetes mellitus (PTDM) and prediabetes (impaired glucose tolerance [IGT] and impaired fasting glucose [IFG]) are associated with cardiovascular events. We assessed the diagnostic performance of fasting plasma glucose (FPG) and HbA1c as alternatives to oral glucose tolerance test (OGTT)-derived 2-hour plasma glucose (2hPG) using sensitivity and specificity in 263 kidney transplant recipients (KTRs) from a clinical trial. Between visits at 6, 12, and 24 months after transplantation, 28%-31% of patients switched glycemic category (normal glucose tolerance [NGT], IGT/IFG, PTDM). Correlations of FPG and HbA1c against 2hPG were lower at 6 months (r = 0.59 [FPG against 2hPG]; r = 0.45 [HbA1c against 2hPG]) vs. 24 months (r = 0.73 [FPG against 2hPG]; r = 0.74 [HbA1c against 2hPG]). Up to 69% of 2hPG-defined PTDM cases were missed by conventional HbA1c and FPG thresholds. For prediabetes, concordance of FPG and HbA1c with 2hPG ranged from 6%-9%. In conclusion, in our well-defined randomized trial cohort, one-third of KTRs switched glycemic category over 2 years and although the correlations of FPG and HbA1c with 2hPG improved with time, their diagnostic concordance was poor for PTDM and, especially, prediabetes. Considering posttransplant metabolic instability, FPG's and HbA1c 's diagnostic performance, the OGTT remains indispensable to diagnose PTDM and prediabetes after kidney transplantation.