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Al-Hasani W, Ranasinghe R, Rogers H, Spanier W, Spears K, Gayle C, Long L, Dimitriadis GK, Hunt KF, Vincent RP. Clinical utility of point-of-care glucose testing in the assessment of gestational diabetes: Prospective cohort study. BJOG 2024. [PMID: 38497098 DOI: 10.1111/1471-0528.17811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To assess the clinical utility of point-of-care (POC) capillary blood glucose (CBG) testing in the assessment of gestational diabetes mellitus (GDM) during oral glucose tolerance test (OGTT). DESIGN Prospective cohort study. SETTING Antenatal clinics at King's College Hospital. POPULATION Women screened for GDM between March and June 2020. METHODS The CBG was measured using the POC StatStrip® test and the venous plasma glucose (VPG) was measured by Roche analyser (Cobas 8000 c702). GDM was diagnosed based on the 2015 National Institute for Health and Clinical Excellence (NICE) Clinical Guideline criteria. The two methods were compared statistically using Analyse-It 5.40.2. MAIN OUTCOME MEASURES Diagnostic sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the POC StatStrip® test, compared with VPG measured by reference laboratory method. RESULTS A total of 230 women were included. The number and percentage of women with glucose concentrations above the GDM threshold using the POC StatStrip® test versus laboratory VPG measurement was 15 (6.5%) versus eight (3.4%) at fasting and 105 (45.6%) versus 72 (31.1%) at 2 h, respectively. The sensitivity and specificity values (and 95% CIs) for the POC StatStrip® test were 88% (52%-99%) and 97% (93%-98%) at fasting and 97% (91%-99%) and 79% (71%-84%) at 2 h, respectively. However, the specificity and the NPV for the POC StatStrip® test for concentrations of ≤5.0 mmol/L at fasting or <7.5 mmol/L at 2 h were 100%, and the sensitivity and the PPV for concentrations of >9.5 mmol/L at 2 h were 100%. CONCLUSIONS In our cohort the POC measurement of CBG cannot entirely replace the laboratory method for the OGTT; however, it can be used to rule out/rule in GDM for glucose concentrations of ≤5.0 mmol/L at fasting or <7.5/>9.5 mmol/L at 2 h.
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Affiliation(s)
- Wiaam Al-Hasani
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Ruvini Ranasinghe
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Helen Rogers
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - William Spanier
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Katie Spears
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Carol Gayle
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Lisa Long
- Department of Obstetrics, King's College Hospital NHS Foundation Trust, London, UK
| | - Georgios K Dimitriadis
- Department of Endocrinology, King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Katharine F Hunt
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Royce P Vincent
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Chebrolu P, Chalem A, Ponticiello M, Broderick K, Vaidyanathan A, Lorenc R, Kulkarni V, Onawale A, Mathad JS, Sundararajan R. A community health worker-led program to improve access to gestational diabetes screening in urban slums of Pune, India: Results from a mixed methods study. PLOS Glob Public Health 2023; 3:e0001622. [PMID: 37889879 PMCID: PMC10610081 DOI: 10.1371/journal.pgph.0001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/14/2023] [Indexed: 10/29/2023]
Abstract
The World Health Organization recommends all pregnant women receive screening for gestational diabetes (GDM) with a fasting oral glucose tolerance test (OGTT). However, very few women receive recommended screening in resource-limited countries like India. We implemented a community health worker (CHW)-delivered program to evaluate if home-based, CHW-delivered OGTT would increase GDM screening in a low-resource setting. We conducted a mixed methods study in two urban slum communities in Pune, India. CHWs were trained to deliver home-based, point-of-care fasting OGTT to women in their third trimester of pregnancy. The primary outcome was uptake of CHW-delivered OGTT. Secondary outcomes included GDM prevalence and linkage to GDM care. Individual interviews were conducted with purposively sampled pregnant women, CHWs, and local clinicians to assess barriers and facilitators of this approach. From October 2021-June 2022, 248 eligible pregnant women were identified. Of these, 223 (90%) accepted CHW-delivered OGTT and 31 (14%) were diagnosed with GDM. Thirty (97%) women diagnosed with GDM subsequently sought GDM care; only 10 (33%) received lifestyle counseling or pharmacologic therapy. Qualitative interviews indicated that CHW-delivered testing was considered highly acceptable as home-based testing saved time and was more convenient than clinic-based testing. Inconsistent clinical management of GDM was attributed to providers' lack of time to deliver counseling, and perceptions that low-income populations are not at risk for GDM. Convenience and trust in a CHW-delivered GDM screening program resulted in high access to gold-standard OGTT screening and identification of a high GDM prevalence among pregnant women in two urban slum communities. Appropriate linkage to care was limited by clinician time constraints and misperceptions of GDM risk. CHW-delivered GDM screening and counseling may improve health education and access to preventive healthcare, offloading busy public clinics in high-need, low-resource settings.
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Affiliation(s)
- Puja Chebrolu
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Andrea Chalem
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Matthew Ponticiello
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Kathryn Broderick
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Arthi Vaidyanathan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Rachel Lorenc
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | | | | | - Jyoti S. Mathad
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
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Jamieson EL, Dimeski G, Flatman R, Hickman PE, Ross Dallas Jones G, V Marley J, David McIntyre H, McNeil AR, Nolan CJ, Potter JM, Sweeting A, Ward P, Williams P, Rita Horvath A. Oral glucose tolerance test to diagnose gestational diabetes mellitus: Impact of variations in specimen handling. Clin Biochem 2022; 115:33-48. [PMID: 36244469 DOI: 10.1016/j.clinbiochem.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/10/2022] [Accepted: 10/04/2022] [Indexed: 11/03/2022]
Abstract
To improve birth outcomes, all pregnant women without known diabetes are recommended for an oral glucose tolerance test (OGTT) to screen for hyperglycaemia in pregnancy (diabetes in pregnancy or gestational diabetes mellitus (GDM)). This narrative review presents contemporary approaches to minimise preanalytical glycolysis in OGTT samples with a focus on GDM diagnosis using criteria derived from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. The challenges of implementing each approach across a diverse Australian healthcare setting were explored. Many Australian sites currently collect and transport OGTT samples at ambient temperature in sodium fluoride (NaF) tubes which is likely to lead to missed diagnosis of GDM in a significant proportion of cases. Alternative preanalytical solutions should be pragmatic and tailored to individual settings and as close as possible to the preanalytical conditions of the HAPO study for correct interpretation of OGTT results. Rapid centrifugation of barrier tubes to separate plasma could be suitable in urban settings provided time to centrifugation is strictly controlled. Tubes containing NaF and citrate could be useful for remote or resource poor settings with long delays to analysis but the impact on the interpretation of OGTT results should be carefully considered. Testing venous blood glucose at the point-of-care bypasses the need for glycolytic inhibition but requires careful selection of devices with robust analytical performance. Studies to evaluate the potential error of each solution compared to the HAPO protocol are required to assess the magnitude of misdiagnosis and inform clinicians regarding the potential impact on patient safety and healthcare costs.
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Boriboonhirunsarn D, Robkhonburi A, Asad-Dehghan M. Accuracy of capillary blood glucose for 50-g glucose challenge test for gestational diabetes screening. Diabetol Int 2022; 13:561-5. [PMID: 35693996 DOI: 10.1007/s13340-022-00572-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
Purpose To assess the accuracy of capillary blood glucose (CBG) compared to conventional venous plasma glucose (VPG) testing for 50-g glucose challenge test (GCT) in gestational diabetes (GDM) screening. Methods A total of 300 women were enrolled and 50-g GCT for GDM screening was offered. At 1 h after glucose loading, CBG was evaluated by CONTOUR® PLUS glucose meter by well-trained nurses immediately after venipuncture for VPG. Results of CBG were compared with those from VPG to evaluate its accuracy. Women with venous plasma glucose > 140 mg/dL were offered 100-g OGTT for GDM diagnosis. Results The mean age was 30.2 years and the mean gestational age at testing was 21.8 weeks. GDM was diagnosed in 34 women (11.3%). The mean VPG was 142.1 ± 32.9 mg/dL and the mean CBG was 129.3 ± 33.5 mg/dL. Mean difference was -12.3 ± 12.5 mg/dL, corresponding to -8.8 ± 11.4%. CBG significantly correlated with VPG with correlation coefficient of 0.929, p < 0.001. In the detection of abnormal 50-g GCT results (VPG ≥ 140 mg/dL), at 126 mg/dL cutoff, CBG had sensitivity of 92.5%, specificity of 81.8%, and positive and negative predictive values of 82.8%and 92%. None of the GDM would have been missed if CBG was used. Conclusion CBG by a certified glucose meter could be considered as an alternative to conventional VPG testing for 50-g GCT for GDM screening using 126 mg/dL cutoff value.
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Ana Y, Prafulla S, Deepa R, Babu GR. Emerging and Public Health Challenges Existing in Gestational Diabetes Mellitus and Diabetes in Pregnancy. Endocrinol Metab Clin North Am 2021; 50:513-530. [PMID: 34399959 DOI: 10.1016/j.ecl.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We review the evidence available worldwide on the various challenges in the screening, management, prevention of gestational diabetes mellitus and diabetes in pregnancy. The use of multiple screening and diagnostic tests prescribed by numerous guidelines is challenging for practitioners. Also, sociocultural, demographic and economic challenges affect the prevention and care. Life-course perspectives need to be adopted, as well as an integrated approach in public health care is essential. Tackling these challenges at each phase of life-course, with development and adherence to the country-specific guidelines by practitioners can decrease the burden of gestational diabetes mellitus and diabetes in pregnancy.
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Affiliation(s)
- Yamuna Ana
- Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, 1st Cross, Magadi Road, Bangalore 560023, Karnataka, India
| | - Shriyan Prafulla
- Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, 1st Cross, Magadi Road, Bangalore 560023, Karnataka, India
| | - Ravi Deepa
- Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, 1st Cross, Magadi Road, Bangalore 560023, Karnataka, India
| | - Giridhara R Babu
- Lifecourse Epidemiology, Public Health Foundation of India, IIPH-H, Bangalore Campus, SIHFW Premises, Beside Leprosy Hospital, 1st Cross, Magadi Road, Bangalore 560023, Karnataka, India.
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Eldem S, Oskovi-Kaplan ZA, Engin-Ustun Y, Yilmaz C, Caglar AT, Ozgu-Erdinc AS. Different pre-analytical techniques and the results of 50 g oral glucose challenge tests. Eur J Clin Invest 2021; 51:e13481. [PMID: 33350460 DOI: 10.1111/eci.13481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/28/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We aimed to analyse the pre-analytical process and its effect of 50 g of oral glucose challenge test results for screening gestational diabetes mellitus. RESEARCH DESIGN AND METHODS The 50 g oral glucose challenge test was performed to 30 pregnant women, and the blood was collected as two samples for three tubes containing; serum separating jell (SSJ), sodium fluoride-potassium oxalate (NaF - KOx) and sodium citrate-containing tube. The first samples of the three tubes were centrifuged within 30 minutes, and second samples were centrifuged after 60 minutes and were analysed. One sample in SSJ tube and was analysed in the same day according to hospitals routine practice. The results were compared. RESULTS Among the 30 samples, the mean decrease in glucose levels was highest in the SSJ tube (0.38 mmol/L), followed by 0.16 mmol/L in Na citrate tube and 0.14 mmol/L in NaF-KOx tube. The hospital routine assessment with SSJ was 6.36 ± 1.90 mmol/L. The <30 and >60 minutes glucose results were 6.80 ± 1.88 mmol/L vs 6.42 ± 1.97 mmol/L for SSJ, 5.95 ± 1.60 mmol/L vs 5.78 ± 1.51 mmol/L for Na Citrate and 6.90 ± 1.86 mmol/L vs 6.75 ± 1.90 mmol/L for NaF-KOx mg/dL groups, respectively, and both the changes within time and the results between the tubes showed a statistically significant difference (P < .001). CONCLUSION In cases with longer assessment time and with different blood sample tubes, the clinician should also keep in mind that, especially with results under but close to the cut-off levels, an underdiagnosed gestational diabetes might be present.
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Affiliation(s)
- Sinem Eldem
- Department of Obstetrics and Gynecology, Yozgat State Hospital, Ankara, Turkey
| | - Z Asli Oskovi-Kaplan
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Yaprak Engin-Ustun
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Canan Yilmaz
- Faculty of Medicine, Department of Biochemisty, Gazi University, Ankara, Turkey
| | - Ali Turhan Caglar
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - A Seval Ozgu-Erdinc
- Department of Obstetrics and Gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
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Nevander S, Landberg E, Blomberg M, Ekman B, Lilliecreutz C. Comparison of Venous and Capillary Sampling in Oral Glucose Testing for the Diagnosis of Gestational Diabetes Mellitus: A Diagnostic Accuracy Cross-Sectional Study Using Accu-Chek Inform II. Diagnostics (Basel) 2020; 10:diagnostics10121011. [PMID: 33255868 PMCID: PMC7760160 DOI: 10.3390/diagnostics10121011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a common complication with negative impacts on mother and child. The primary aim of this study was to examine whether plasma glucose cutoffs for GDM diagnosis based on venous sampling can be replaced by cutoffs based on capillary sampling. A prospective cross-sectional study was performed at an antenatal care clinic including 175 pregnant women undergoing an oral glucose tolerance test (OGTT). Duplicate samples were collected by capillary and venous puncture while fasting and 1 h and 2 h after an OGTT. Both samples were analyzed on Accu-Chek Inform II. The cutoffs for a GDM diagnosis using capillary samples were corrected from 5.1 to 5.3 mmol/L for the fasting sample, from 10.0 to 11.1 mmol/L for the 1 h sample, and from 8.5 to 9.4 mmol/L for the 2-h sample using half of the dataset. Applying these cutoffs to the remaining dataset resulted in a sensitivity, specificity, and accuracy of 85.0%, 95.0%, and 90.3%, respectively, with a positive predictive value (PPV) of 83%, an negative predictive value (NPV) of 96%, and a positive negative likelihood ratio (LHR) of 16.4 using capillary sampling for the GDM diagnosis at fasting and 2-h after. Corrected cutoffs and capillary samples can be used for the diagnosis of GDM with maintained diagnostic accuracy using Accu-Chek Inform II.
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Affiliation(s)
- Sofia Nevander
- Department of Obstetrics and Gynecology, Linköping University, SE-581 85 Linköping, Sweden; (M.B.); (C.L.)
- Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85 Linköping, Sweden;
- Correspondence: ; Tel.: +46-(705)-397-979
| | - Eva Landberg
- Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85 Linköping, Sweden;
- Department of Clinical Chemistry, Linköping University, SE-581 85 Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology, Linköping University, SE-581 85 Linköping, Sweden; (M.B.); (C.L.)
- Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85 Linköping, Sweden;
| | - Bertil Ekman
- Department of Endocrinology, Linköping University, SE-581 85 Linköping, Sweden;
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Caroline Lilliecreutz
- Department of Obstetrics and Gynecology, Linköping University, SE-581 85 Linköping, Sweden; (M.B.); (C.L.)
- Department of Biomedical and Clinical Sciences, Linköping University, SE-581 85 Linköping, Sweden;
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Maidwell-Smith AA, Doel AM, Bernstein RM, Moore SE. Prevalence estimates of diabetes in pregnancy in a rural, sub-Saharan population. Diabetes Res Clin Pract 2020; 169:108455. [PMID: 32979418 PMCID: PMC7738751 DOI: 10.1016/j.diabres.2020.108455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/17/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022]
Abstract
AIMS To determine the prevalence of Hyperglycaemia first Detected in Pregnancy (HDIP) in a cohort of women from rural Gambia and compare the diagnostic ability of capillary blood glucose (CBG) sampling to identify HIP versus laboratory-based analysis of venous plasma glucose (VPG). METHODS Pregnant women from rural Gambia (N = 251) underwent a 75 g Oral Glucose Tolerance Test (OGTT) at 28-weeks of gestation. Gestational Diabetes Mellitus was assessed as fasting glucose concentration ≥ 5.1-6.9 mmol/L; ≥10.0 mmol/L at 1-h post load; or ≥ 8.5 mmol/L at 2-h post load and Diabetes in Pregnancy as fasting glucose > 7.0 mmol/L. RESULTS A total of 199 and 244 women had VPG and CBG measurements respectively, and 198 women had both. 32 women (16.1%) were diagnosed with HDIP using VPG, mostly based on fasting concentrations. CONCLUSIONS The prevalence of HDIP in rural Gambia was higher than anticipated, emphasising a need for maternal diabetic policy. Based on the current findings, tailored recommendations could include measuring fasting VPG alone when conducting a full OGTT is not feasible. Similarly, CBG may be of value for excluding disease and thereby limiting costly laboratory-based investigations to a select few.
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Affiliation(s)
| | - Andrew M Doel
- Department of Women and Children's Health, King's College London, London, UK
| | - Robin M Bernstein
- Department of Anthropology, University of Colorado, Boulder, CO, USA; Health and Society Program, Institute of Behavioural Science, University of Colorado, Boulder, CO, USA
| | - Sophie E Moore
- Department of Women and Children's Health, King's College London, London, UK; MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Gambia.
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Matos ALS, Moreira JPDL, Luiz RR, da Silva EP, Rodacki M, Gómez JFB, Zajdenverg L. Comparison of glucose measurement on dried blood spots versus plasma samples in pregnant women with and without anemia. Arch Endocrinol Metab 2020; 64:454-461. [PMID: 32267357 PMCID: PMC10522073 DOI: 10.20945/2359-3997000000229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022]
Abstract
Objective Compare the concordance degree between plasma glucose and glucose measurements on Dried Blood Spots (DBS) during pregnancy. Subjects and methods Glucose measurement was performed in pregnant women after a fast of 8-12 hours. Venous blood was collected with sodium fluoride, the plasma was separated, and glucose measured by the enzymatic oxidase glucose method. Capillary blood samples were collected and analyzed by DBS. For statistics, the paired Student's t test, interclass correlation coefficient (ICC), graphic approach of Altman and Bland, and survival - concordance plot were used. Results 307 pregnant women were evaluated, 88.6% without diabetes and 11.4% with previous diabetes. The glucose ranged from 66 to 190 mg/dL [3.66 to 10.55 mmol/L] in plasma and from 53 to 166 mg/dL [2.94 to 9.21 mmol/L] in DBS. The glucose average values were 88.1 ± 12 mg/dL [4.98 ± 0.67 mmol/L] in plasma and 89.2 ±11,5 mg/dL, [4.95 ± 0.64 mmol/L] in DBS - p-value = 0.084. The ICC value was moderate (0.510), and Pearson's correlation coefficient was r = 0.507 p < 0.001. Altman and Bland's graph showed that difference between the values obtained by both methods is -24.62 to 22.3 mg/dL [-1.37 to 1.24 mmol/L]. Significant fixed bias (-1,16 average difference) and proportional bias (r = 0.056; p = 0.33) were not observed. Anemia was associated with differences between plasma glucose and DBS measurements (p = 0.031). Conclusion Capillary glucose in DBS correlates with plasma glucose; however, the methods do not present good concordance. The presence of anemia worsens this result.
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Affiliation(s)
- Ana Lígia Soares Matos
- Maternidade EscolaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilMaternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Jessica Pronestino de Lima Moreira
- Instituto de Estudos de Saúde ColetivaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilInstituto de Estudos de Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Ronir Raggio Luiz
- Instituto de Estudos de Saúde ColetivaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilInstituto de Estudos de Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Evelise Pochmann da Silva
- Maternidade EscolaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilMaternidade Escola, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Melanie Rodacki
- Departamento de Medicina InternaUnidade de Diabetes e NutrologiaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilDepartamento de Medicina Interna, Unidade de Diabetes e Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | | | - Lenita Zajdenverg
- Departamento de Medicina InternaUnidade de Diabetes e NutrologiaUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilDepartamento de Medicina Interna, Unidade de Diabetes e Nutrologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
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O'Malley EG, Reynolds CME, O'Kelly R, Killalea A, Sheehan SR, Turner MJ. A Prospective Evaluation of Point-of-Care Measurements of Maternal Glucose for the Diagnosis of Gestational Diabetes Mellitus. Clin Chem 2020; 66:316-323. [PMID: 32040574 DOI: 10.1093/clinchem/hvz005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/27/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Point-of-care (POC) measurement of glucose is currently recommended only for the monitoring of gestational diabetes mellitus (GDM). This prospective observational study evaluated the use of POC measurements of maternal glucose to diagnose GDM in women being screened selectively with a 1-step 75 g oral glucose tolerance test (OGTT). METHODS The strictest preanalytic and analytic international laboratory standards were applied to measure maternal plasma glucose at fasting and at 1 and 2 h post glucose load. The recent International Association of Diabetes and Pregnancy Study Groups diagnostic criteria were used. At the same time, maternal capillary glucose was measured. Because of differences in plasma and capillary glucose measurements, regression analysis of POC capillary glucose results vs laboratory plasma glucose results was conducted. The regression equations for plasma glucose were derived in a derivation cohort (n = 102). These equations were applied in the validation cohort (n = 100). Predicted and actual plasma glucose values were compared. RESULTS Of the 202 women screened, 36.6% were nulliparous, 56.4% were obese, and 81.2% were Irish-born. Two thirds had a single risk factor for GDM, and a third had multiple risk factors. Based on the plasma measurements, 53.5% had GDM. As a predictor of GDM, the diagnostic accuracy of POC measurement was 83.0% (95% confidence interval, 74.2-89.8). CONCLUSIONS In high-resource settings where measures to inhibit glycolysis are implemented, the use of POC measurements for the diagnosis of GDM is not justified based on this study. In low- and medium-resource settings, where measures to inhibit glycolysis are not achievable, regression analysis using POC measurements may be acceptable compared with plasma samples subject to glycolysis.
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Affiliation(s)
- Eimer G O'Malley
- UCD Centre for Human Reproduction, Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Ciara M E Reynolds
- UCD Centre for Human Reproduction, Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Ruth O'Kelly
- Department of Biochemistry, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Anne Killalea
- Department of Biochemistry, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Sharon R Sheehan
- UCD Centre for Human Reproduction, Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Michael J Turner
- UCD Centre for Human Reproduction, Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
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García-Claver A, Ramos-Corral R, Laviña-Fañanás C, Solans-Blecua I, Puzo-Foncillas J. Capillary glucose concentration during oral glucose tolerance test for the diagnosis of gestational diabetes. Int J Gynaecol Obstet 2020; 150:234-240. [PMID: 32320486 DOI: 10.1002/ijgo.13178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/07/2020] [Accepted: 04/17/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess concordance between two point-of-care testing (POCT) devices and the standard laboratory method in screening for gestational diabetes mellitus (GDM) in Huesca. METHODS Pregnant women who met criteria for an oral glucose tolerance test (OGTT) and attended the laboratory between October 2017 and November 2018 were recruited in this prospective observational study. Glucose was measured in venous (laboratory) and capillary blood (Accu-Chek or Contour Next glucometers). GDM was diagnosed attending to NDDG criteria for venous samples or capillary-specific cut-off. Linear regression, Passing-Bablok, Bland-Altman, and the kappa coefficient were used to study concordance between POCT and laboratory method. RESULTS Data from 109 women were analyzed (57 for Accu-Chek, 52 for Contour Next). Statistical analyses showed good agreement between both POCT and laboratory method. There were no statistical differences in fasting glucose measurements between capillary and venous samples and both POCT devices meet the ISO 15197 standard. Accu-Chek showed good agreement (k=0.629) regarding the laboratory method in classifying GDM, with an acceptable inter-evaluator bias of 3.5% (P<0.001). CONCLUSION POCT can be used to obtain fasting values and reduce overall waiting times for patients. Additionally, Accu-Chek can be used to diagnose GDM in remote areas applying specific cut-off values.
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Affiliation(s)
| | - Raquel Ramos-Corral
- Laboratory Medicine Service, Infanta Sofia Hospital- BR Salud, Madrid, Spain
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O'Malley EG, Reynolds CME, Turner MJ. Letter to the editor - Brief Communication. Eur J Obstet Gynecol Reprod Biol 2020; 249:106. [PMID: 32029286 DOI: 10.1016/j.ejogrb.2020.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/23/2020] [Accepted: 01/29/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Eimer G O'Malley
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland.
| | - Ciara M E Reynolds
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Michael J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
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Coetzee A, van de Vyver M, Hoffmann M, Hall DR, Mason D, Conradie M. A comparison between point-of-care testing and venous glucose determination for the diagnosis of diabetes mellitus 6-12 weeks after gestational diabetes. Diabet Med 2019; 36:591-599. [PMID: 30663133 DOI: 10.1111/dme.13903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2019] [Indexed: 01/17/2023]
Abstract
AIM To evaluate point-of-care-testing (POCT) for the diagnosis of Type 2 diabetes mellitus 6-12 weeks post-partum in women with gestational diabetes (GDM). METHODS Post-partum glucose assessment (75-mg oral glucose tolerance test, OGTT) was performed prospectively in 122 women with GDM (1 November 2015 to 1 November 2017) at Tygerberg Hospital, Cape Town, South Africa. Individuals with known pre-existing diabetes were excluded. The accuracy and clinical utility of POCT (capillary finger-prick) were compared with laboratory plasma glucose (hexokinase and glucokinase methods). The OGTT consisted of two time points (fasting and 2 h) during which concurrent glucose samples (POCT and laboratory) were obtained. Bland-Altman plots and paired analysis were used to assess the analytical accuracy of POCT, whereas its diagnostic performance was determined using positive and negative predictive values to calculate specificity and sensitivity. RESULTS Spearman's ranked correlation analysis indicated a strong association between POCT and laboratory glucose values at both OGTT time points (fasting, r = 0.95, P < 0.0001; 2 h, r = 0.88, P < 0.0001). Thirty-six women were diagnosed with Type 2 diabetes based on gold standard laboratory glucose levels (fasting > 7 mmol/l; 2 h > 11.1 mmol/l). POCT correctly identified Type 2 diabetes in 78% of women (28 of 36) with a positive predictive value of 89.3% and a negative predictive value of 96.7% at the fasting time point. The sensitivity and specificity of POCT to diagnose Type 2 diabetes were 89% (fasting), 85.7% (2 h) and 96.7% (fasting), 98.5% (2 h) respectively. POCT proved less sensitive to diagnose pre-diabetes (69%) but displayed satisfactory specificity (92%) at both time points assessed. CONCLUSION POCT accurately identifies women with Type 2 diabetes 6-12 weeks after GDM.
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Affiliation(s)
- A Coetzee
- Department of Medicine, Stellenbosch University, Cape Town, South Africa
- Tygerberg Academic Hospital, Cape Town, South Africa
| | - M van de Vyver
- Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - M Hoffmann
- Department of Pathology, Stellenbosch University and the National Health Laboratory Service, Cape Town, South Africa
| | - D R Hall
- Tygerberg Academic Hospital, Cape Town, South Africa
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - D Mason
- Tygerberg Academic Hospital, Cape Town, South Africa
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - M Conradie
- Department of Medicine, Stellenbosch University, Cape Town, South Africa
- Tygerberg Academic Hospital, Cape Town, South Africa
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Wahlberg J, Ekman B, Arnqvist HJ. Most Women with Previous Gestational Diabetes Mellitus Have Impaired Glucose Metabolism after a Decade. Int J Mol Sci 2018; 19:ijms19123724. [PMID: 30477103 PMCID: PMC6321586 DOI: 10.3390/ijms19123724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/16/2022] Open
Abstract
Of 1324 women diagnosed with gestational diabetes mellitus (GDM) in Sweden, 25% reported >10 years after the delivery that they had developed diabetes mellitus. We assessed the long-term risk of all glucose metabolic abnormalities in a subgroup of these women. Women (n = 51) previously diagnosed with GDM by capillary blood glucose ≥9.0 mmol/L (≈plasma glucose ≥10.0 mmol/L) after a 2 h 75 g oral glucose tolerance test (OGTT) were included. All underwent a clinical and biochemical evaluation, including a second 2 h 75 g OGTT. Individuals with known type 1 diabetes were excluded. At the follow-up, 12/51 (24%) reported previously diagnosed type 2 diabetes. Another four cases were diagnosed after the second OGTT, increasing the prevalence to 16/51 cases (31%). Impaired fasting plasma glucose (IFG) was diagnosed in 13/51 women and impaired glucose tolerance (IGT) in 10/51 women, leaving only 12 women (24%) with normal glucose tolerance. In addition, 2/51 women had high levels of glutamic acid decarboxylase (GAD) antibodies; of these, one woman classified as type 2 diabetes was reclassified as type 1 diabetes, and the second GAD-positive woman was diagnosed with IGT. Of the women diagnosed with GDM by a 2 h 75 g OGTT, a large proportion had impaired glucose metabolism a decade later, including type 1 and type 2 diabetes.
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Affiliation(s)
- Jeanette Wahlberg
- Department of Endocrinology and Department of Medical and Health Sciences, Linköping University, S-581 85 Linköping, Sweden.
- Department of Endocrinology and Department of Clinical and Experimental Medicine, Linköping University, S-581 85 Linköping, Sweden.
| | - Bertil Ekman
- Department of Endocrinology and Department of Medical and Health Sciences, Linköping University, S-581 85 Linköping, Sweden.
| | - Hans J Arnqvist
- Department of Endocrinology and Department of Clinical and Experimental Medicine, Linköping University, S-581 85 Linköping, Sweden.
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Adam S, Rheeder P. Evaluating the utility of a point-of-care glucometer for the diagnosis of gestational diabetes. Int J Gynaecol Obstet 2017; 141:91-96. [PMID: 29164614 DOI: 10.1002/ijgo.12399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/05/2017] [Accepted: 11/21/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the performance of the Roche Accuchek Active glucometer in diagnosing gestational diabetes mellitus (GDM) versus the gold-standard laboratory test. METHODS In a prospective cohort observational study at a primary healthcare clinic in Johannesburg, South Africa, pregnant women, excluding known diabetics, were recruited between 2013 and 2016. A 75-g 2-hour oral glucose tolerance test (OGTT) was scheduled at 24-28 gestational weeks. Glucose was measured in venous blood (laboratory) and capillary blood (glucometer). GDM was diagnosed via FIGO criteria. Diagnostic accuracy was evaluated by calculating the sensitivity, specificity, and coefficient of variance (CV) of the glucometer test, and by Bland-Altman plots. RESULTS Data from 529 women were analyzed. Of these, 141 (26.7%) and 79 (14.9%) were diagnosed with GDM by laboratory and glucometer measurements, respectively. The CV of the glucometer ranged from 15% to 17%. Bland-Altman plots showed a positive bias of the glucometer results at 0 hours, but a negative bias at 1 and 2 hours of the OGTT. The sensitivity and specificity of the glucometer for the diagnosis of GDM were 27.0% and 89.4%, respectively. CONCLUSION Use of the Roche Accuchek Active glucometer for the diagnosis of GDM cannot be recommended.
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Affiliation(s)
- Sumaiya Adam
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Paul Rheeder
- Department of Internal Medicine, University of Pretoria, Pretoria, South Africa
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