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Scavenius C, Petersen ERB, Jensen DM, Ringholm L, Danielsen JS, Mathiesen ER, McIntyre D, Damm P, Overgaard M, Clausen TD. Pre-analytical diagnostic differences despite high adherence to guidelines for gestational diabetes mellitus. Scand J Clin Lab Invest 2024; 84:30-37. [PMID: 38319177 DOI: 10.1080/00365513.2024.2312152] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/07/2024] [Indexed: 02/07/2024]
Abstract
Regional variations in the prevalence of gestational diabetes mellitus (GDM) have been found across Denmark. The objectives of this exploratory survey were to evaluate adherence to the national guideline for screening and diagnosing GDM and to identify variations in pre-analytical or analytical factors, which could potentially contribute to variations in GDM prevalence across regions. In a national interview-based survey, obstetric departments and laboratories throughout Denmark handling GDM screening or diagnostic testing were invited to participate. Survey questionnaires were completed through personal interviews. In total, 21 of 22 identified obstetric departments and 44 of 45 identified laboratories participated. Adherence to guideline among obstetric departments ranged 67-100% and uniformity in laboratory procedures was high. However, the gestational age at the time of late diagnostic testing with oral glucose tolerance test (OGTT) varied considerably, with 48% (10/21) of departments testing outside the recommended 24-28 weeks' gestation. Procedural heterogeneity was most pronounced for the parts not described in current guidelines, with choice of laboratory equipment being the most diverse factor ranging 3-39% nationally. In conclusion, the overall adherence to the national guidelines was high across regions, and obstetric departments and laboratories had high uniformity in the procedures for screening and diagnosing GDM. Uniformity was generally high for procedures included in the guideline and low if not included. However, a high proportion of GDM testing was performed outside the recommended gestational window in late pregnancy, which may be a pre-analytical contributor to regional differences in GDM prevalence.
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Affiliation(s)
- Cathrine Scavenius
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | | | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lene Ringholm
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Rigshospitalet, København, Denmark
| | - Jakoba Sevdal Danielsen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital Hillerød, Hillerød, Denmark
| | - Elisabeth Reinhardt Mathiesen
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Rigshospitalet, København, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - David McIntyre
- Mater Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Peter Damm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, København, Denmark
| | - Martin Overgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - Tine Dalsgaard Clausen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, København, Denmark
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Bakkebø H, Haaland KL, Hoff KS, Schwettmann L. Five days serum glucose stability at room-temperature in centrifuged fast-clotting serum tubes and the comparability with glucose in heparin-plasma and plasma containing citrate-stabilizer. Scand J Clin Lab Invest 2024; 84:62-67. [PMID: 38451167 DOI: 10.1080/00365513.2024.2318617] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 02/10/2024] [Indexed: 03/08/2024]
Abstract
Glucose measurement plays a central role in the diagnosis of gestational diabetes mellitus (GDM). Because of earlier reports of overestimation of glucose in the widely used tubes containing granulated glycolysis inhibitor, the study assessed the performance of fast-clotting serum tubes as an alternative sample for the measurement of glucose. Glucose concentration in fast-clotting serum was compared to lithium-heparin plasma placed in an ice-water slurry after sample collection and glucose stability at room-temperature was studied. Blood samples from 30 volunteers were drawn in four different types of tubes (serum separator tubes, fast-clotting serum tubes, lithium-heparin tubes and sodium fluoride, EDTA and a citrate buffer (NaF-EDTA-citrate) tubes, all from Greiner Bio-One). Lithium-heparin tubes were placed in an ice-water slurry until centrifugation in accordance with international recommendations and centrifuged within 10 min. After centrifugation, glucose was measured in all tubes (timepoint T0) and after 24, 48, 72, 96 and 120 h of storage at 20-22 °C. NaF-EDTA-citrate plasma showed significant overestimation of glucose concentration by 4.7% compared to lithium-heparin plasma; fast-clotting serum showed glucose concentrations clinically equivalent to lithium-heparin plasma. In fast-clotting serum tubes, mean bias between glucose concentration after 24, 48, 72, 96 and 120 h and T0 was less than 2.4%. All individual differences compared to T0 were less than 6.5%. The results fulfill the acceptance criteria for sample stability based on biological variation. Fast-clotting serum tubes can be an alternative for the measurement of glucose in diagnosis and management of GDM and diabetes mellitus, especially when prolonged transportation is necessary.
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Affiliation(s)
- Hanne Bakkebø
- Department of Biological Sciences Ålesund, Norwegian University of Science and Technology, Aalesund, Norway
| | - Karen Lund Haaland
- Department of Biological Sciences Ålesund, Norwegian University of Science and Technology, Aalesund, Norway
| | - Kristin Solli Hoff
- Department of Biological Sciences Ålesund, Norwegian University of Science and Technology, Aalesund, Norway
| | - Lutz Schwettmann
- Department of Biological Sciences Ålesund, Norwegian University of Science and Technology, Aalesund, Norway
- Department of Medical Biochemistry, Clinical Diagnostic Center, Aalesund Hospital, Aalesund, Norway
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Munk Scheuer C, Duevang Tvarnø C, Gils C, Dahl Ravn J, David McIntyre H, Møller Jensen D, Damm P, Kepp Bruun Lauenborg J, Dalsgaard Clausen T, Overgaard M. The impact of inter-laboratory glucose bias on the diagnosis of gestational diabetes mellitus: Comparison of common automated central laboratory methods. Clin Chim Acta 2023:117414. [PMID: 37263535 DOI: 10.1016/j.cca.2023.117414] [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: 05/03/2023] [Revised: 05/07/2023] [Accepted: 05/27/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND AIMS The diagnosis of gestational diabetes mellitus (GDM) is based exclusively on glucose measurements, which are highly influenced by pre-analytical and analytical factors. Therefore, poor agreement across laboratories may affect the prevalence of GDM. We aimed to determine the inter-laboratory bias of glucose measurements and the impact on GDM prevalence. MATERIAL AND METHODS A prospective cohort study of women (n=110) referred for second-trimester GDM diagnostics using a 75 g oral glucose tolerance test. Maternal glucose was assessed from venous plasma at fasting, 1 h and 2 h. Venous blood were collected in Fluoride Citrate tubes and frozen. Samples were analyzed at five central laboratories using four different automated glucose Hexokinase methods and GDM prevalence was evaluated according to WHO2013 diagnostic criteria. RESULTS Maximum inter-laboratory bias was 0.19, 0.30 and 0.27 mmol/L in fasting, 1 h and 2 h samples, respectively. GDM prevalence ranged 30.0-41.1% across laboratories. CONCLUSION Inter-laboratory bias for mean venous glucose was low and within desirable limits. Nonetheless, the impact on GDM prevalence was considerable, which may inappropriately affect clinical practice.
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Affiliation(s)
- Cathrine Munk Scheuer
- Shared first authorship; Department of Gynaecology and Obstetrics, University of Copenhagen, Nordsjællands Hospital. Dyrehavevej 29, DK-3400 Hillerød.
| | - Casper Duevang Tvarnø
- Shared first authorship; Department of Gynaecology, Obstetrics and Paediatrics, Nykøbing Falster Sygehus, Denmark. Fjordvej 15, DK-4800 Nykøbing Falster.
| | - Charlotte Gils
- Department of Clinical Biochemistry, Odense University Hospital, Denmark. J.B. Winsløws Vej 4, DK-5000 Odense C.
| | - Julie Dahl Ravn
- Department of Clinical Biochemistry, Odense University Hospital, Denmark. J.B. Winsløws Vej 4, DK-5000 Odense C.
| | - H David McIntyre
- Mater Research, Faculty of Medicine, The University of Queensland, Australia. Raymond Terrace, Level 3 Aubigny Place, South Brisbane QLD 4101, Australia.
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Denmark Kløvervænget 10, DK-5000 Odense C; Department of Gynecology and Obstetrics, Odense University Hospital, Denmark. J.B. Winsløws Vej 4, DK-5000 Odense C; Department of Clinical Research, University of Southern Denmark, Denmark. J.B. Winsløws Vej 19.3, DK-5000 Odense C.
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Denmark. Blegdamsvej 9, DK-2100 Copenhagen East; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Blegdamsvej 3b 33.5. DK-2200 Copenhagen.
| | - Jeannet Kepp Bruun Lauenborg
- Department of Gynaecology, Obstetrics and Paediatrics, Nykøbing Falster Sygehus, Denmark. Fjordvej 15, DK-4800 Nykøbing Falster; Department of Gynaecology and Obstetrics, Copenhagen University Hospital Herlev, Denmark. Borgmester Ib Juuls Vej 11, DK-2730 Herlev.
| | - Tine Dalsgaard Clausen
- Department of Gynaecology and Obstetrics, University of Copenhagen, Nordsjællands Hospital. Dyrehavevej 29, DK-3400 Hillerød; Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, Denmark. Blegdamsvej 9, DK-2100 Copenhagen East.
| | - Martin Overgaard
- Department of Clinical Biochemistry, Odense University Hospital, Denmark. J.B. Winsløws Vej 4, DK-5000 Odense C; Department of Clinical Research, University of Southern Denmark, Denmark. J.B. Winsløws Vej 19.3, DK-5000 Odense C.
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Szoke D, Borille S, Cardellicchio M, Spadaccini G, Taricco E, Vignali M, Cetin I, Birindelli S, Panteghini M. Impact of optimizing pre-analytical phase on the diagnosis of gestational diabetes and related outcomes. Clin Chem Lab Med 2021; 59:1981-1987. [PMID: 34449173 DOI: 10.1515/cclm-2021-0706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/17/2021] [Accepted: 08/10/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Pre-analytical plasma glucose (PG) sampling methodology may significantly affect gestational diabetes mellitus (GDM) incidence, but no studies directly examined the impact on perinatal outcomes. We compared the effect on oral glucose tolerance test (OGTT) results of using for blood sampling the traditional sodium fluoride (NaF) tubes, batched at controlled temperature, and the more effective citrate-buffered tubes, in terms of GDM diagnosis and related outcomes. METHODS We evaluated 578 pregnant women performing OGTT between 24- and 28-weeks' gestation. Paired NaF and citrate blood samples were drawn and analyzed for PG. GDM diagnosis was made by applying the 'one-step' American Diabetes Association strategy. Data on perinatal outcomes were collected in a subset of 330 women who delivered in our hospital network. RESULTS Using the standard NaF approach, 69 (11.9%) GDM women were detected. Using citrate PG values, 90 women were additionally identified as GDM, increasing the GDM prevalence to 27.5%. Perinatal outcomes were analyzed according to the different diagnostic allocation (NaF-diagnosed GDM, additional citrate-diagnosed GDM, and no GDM). NaF-diagnosed GDM showed a higher incidence of large for gestational age (LGA) (p=0.034), and of cesarean and preterm delivery (p<0.01) vs. no GDM. The only outcome remaining more frequent in the additional citrate diagnosed GDM when compared with no GDM group was LGA (17.2 vs. 6.8%, p=0.025). CONCLUSIONS If a health care system plans to use citrate tubes for GDM diagnosis, considerations about clinical implications are mandatory by balancing higher sensitivity in detecting a poor glycemic control with effects on outcomes to avoid "overdiagnosis".
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Affiliation(s)
| | | | | | | | - Emanuela Taricco
- UOC Ostetricia e Ginecologia Presidio Vittore Buzzi, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Michele Vignali
- UOC Ostetricia e Ginecologia Presidio Macedonio Melloni, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Milan, Italy
| | - Irene Cetin
- UOC Ostetricia e Ginecologia Presidio Luigi Sacco, Milan, Italy.,UOC Ostetricia e Ginecologia Presidio Vittore Buzzi, ASST Fatebenefratelli-Sacco, Milan, Italy.,Dipartimento di Scienze Biomediche e Cliniche "Luigi Sacco", Università degli Studi, Milan, Italy
| | | | - Mauro Panteghini
- UOC Patologia Clinica, Milan, Italy.,Dipartimento di Scienze Biomediche e Cliniche "Luigi Sacco", Università degli Studi, Milan, Italy
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Jensen RC, Jensen DM, Gibbons KS, Glintborg D, Jensen TK, McIntyre HD, Andersen M. Adapting fasting plasma glucose threshold for GDM diagnosis according to the population distribution - An approach to the Danish paradox. Diabetes Res Clin Pract 2021; 175:108832. [PMID: 33895195 DOI: 10.1016/j.diabres.2021.108832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/31/2021] [Accepted: 04/17/2021] [Indexed: 01/15/2023]
Abstract
AIMS To examine third trimester fasting venous plasma glucose (FVPG) according to the distribution of a Danish population of pregnant women and identify potential local FVPG thresholds for GDM diagnosis related to risks of adverse pregnancy outcomes. METHODS In the observational Odense Child Cohort (OCC) study, 1516 women had FVPG measured at 27-28 weeks' gestation and were considered normal by Danish criteria and remained untreated. Maternal FVPG from OCC were standardized according to the local FVPG mean and standard deviation calibrated to data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. Associations between maternal FVPG and clinical and anthropometric outcomes were analysed. Potential FVPG cut points were identified. RESULTS Unadjusted areas under the ROC curve for FVPG to discriminate for large for gestational age (LGA) and hypertensive disorders of pregnancy were 0.61 (95% CI 0.56, 0.67) and 0.57 (95% CI 0.52, 0.63), respectively. The Youden FVPG cut point for LGA was 5.5 mmol/L and 5.0 mmol/L for hypertensive disorders of pregnancy. CONCLUSIONS This study identified a potential locally appropriate third trimester FVPG cut point between 5.5 and 5.7 mmol/L based on LGA risk in pregnancy. This cut point should be validated prospectively in other Danish cohorts.
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Affiliation(s)
- Richard Christian Jensen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Denmark; Department of Endocrinology, Odense University Hospital, Odense C, Denmark.
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense C, Denmark; Department of Gynaecology and Obstetrics, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Kristen S Gibbons
- Faculty of Medicine, The University of Queensland, South Brisbane, QLD 4102, Australia
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Tina Kold Jensen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Denmark; Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark; Odense Patient Data Exploratory Network (OPEN), University of Southern Denmark, Odense C, Denmark
| | - H David McIntyre
- Faculty of Medicine, The University of Queensland, South Brisbane, QLD 4102, Australia; Mater Research, The University of Queensland, South Brisbane, QLD 4102, Australia
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
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6
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Carta M, Bonetti G, Giavarina D. Plasma glucose sampling using lyophilized citrate tubes: impact on the diagnosis of gestational diabetes mellitus. Diabet Med 2021; 38:e14422. [PMID: 33058272 DOI: 10.1111/dme.14422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M Carta
- AULSS n. 8 Berica, Laboratory Medicine Deptment, Vicenza, Italy
| | - G Bonetti
- ASST-Valcamonica, Laboratory of Clinical Pathology, Esine, Italy
| | - D Giavarina
- AULSS n. 8 Berica, Laboratory Medicine Deptment, Vicenza, Italy
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7
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Jamieson EL, Spry EP, Kirke AB, Roxburgh C, Atkinson DN, Marley JV. Underestimation of risk for large babies in rural and remote Australia: Time to change plasma glucose collection protocols. J Clin Transl Endocrinol 2021; 23:100247. [PMID: 33520662 PMCID: PMC7820914 DOI: 10.1016/j.jcte.2020.100247] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 11/29/2022]
Abstract
In remote Australia, many women with GDM are missed due to test sample instability. FC tubes stabilise glucose but markedly increase GDM diagnosis in lower-risk women. Adjustment of FC results lowered GDM and improved risk-assessment for a large baby.
Aims Preanalytical glycolysis in oral glucose tolerance tests (OGTT) leads to substantial underestimation of gestational diabetes mellitus (GDM) and hence risk for large-for-gestational-age (LGA) babies. This paper quantified the impact of glycolysis on identification of LGA risk in a prospective rural and remote Australian cohort. Methods For 495 women, OGTT results from room temperature fluoride-oxalate (FLOX) tubes were algorithmically corrected for estimated glycolysis compared to 1) the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study protocol (FLOX tubes in ice-slurry); and 2) room temperature fluoride-citrate (FC) tubes. GDM was defined by International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Unadjusted and corrected OGTT were related to LGA outcome. Results Correction for FC tubes increased GDM incidence from 9.7% to 44.6%. After correction for HAPO protocol, GDM incidence was 27.7% and prediction of LGA risk (RR 1.82, [1.11–2.99]) improved compared to unadjusted rates (RR 1.12, [0.51–2.47]). To provide similar results for FC tube correction (29.3% GDM; RR 1.81, [1.11–2.96]) required + 0.2 mmol/L adjustment of IADPSG criteria. Conclusions FC tubes present a practical alternative to the HAPO protocol in remote settings but give + 0.2 mmol/L higher glucose readings. Modification of IADPSG criteria would reduce perceived ‘overdiagnosis’ and improve LGA risk-assessment.
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Affiliation(s)
- Emma L Jamieson
- The University of Western Australia, The Rural Clinical School of Western Australia, Building 3 Edith Cowan University Campus, Robertson Drive, PO Box 412, Bunbury 6230, Australia
| | - Erica P Spry
- Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome 6725, Australia.,The University of Western Australia, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome 6725, Australia
| | - Andrew B Kirke
- The University of Western Australia, The Rural Clinical School of Western Australia, Building 3 Edith Cowan University Campus, Robertson Drive, PO Box 412, Bunbury 6230, Australia
| | - Carly Roxburgh
- The University of Western Australia, The Rural Clinical School of Western Australia, 35 Stirling Terrace, Albany 6330, Australia
| | - David N Atkinson
- The University of Western Australia, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome 6725, Australia
| | - Julia V Marley
- Kimberley Aboriginal Medical Services, 12 Napier Terrace, Broome 6725, Australia.,The University of Western Australia, The Rural Clinical School of Western Australia, 12 Napier Terrace, PO Box 1377, Broome 6725, Australia
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8
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Jamieson EL, Spry EP, Kirke AB, Roxburgh C, Atkinson DN, Marley JV. Variations in the Prevalence of Gestational Diabetes Mellitus With Remote Testing and a Pragmatic Solution to Improve Accuracy. Diabetes Care 2021; 44:e4-e5. [PMID: 33168653 PMCID: PMC7783941 DOI: 10.2337/dc20-2211] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Emma L Jamieson
- The Rural Clinical School of Western Australia, The University of Western Australia, Bunbury, Australia
| | - Erica P Spry
- Kimberley Aboriginal Medical Services, Broome, Australia.,The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Australia
| | - Andrew B Kirke
- The Rural Clinical School of Western Australia, The University of Western Australia, Bunbury, Australia
| | - Carly Roxburgh
- The Rural Clinical School of Western Australia, The University of Western Australia, Albany, Australia
| | - David N Atkinson
- The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Australia
| | - Julia V Marley
- Kimberley Aboriginal Medical Services, Broome, Australia.,The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Australia
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Song D, Hurley JC, Lia M. Estimated Treatment Effects of Tight Glycaemic Targets in Mild Gestational Diabetes Mellitus: A Multiple Cut-Off Regression Discontinuity Study Design. Int J Environ Res Public Health 2020; 17:E7725. [PMID: 33105782 PMCID: PMC7660094 DOI: 10.3390/ijerph17217725] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/01/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022]
Abstract
Background: We investigated the treatment effects of tight glycaemic targets in a population universally screened according to the International Association of Diabetes and Pregnant Study Groups (IADPSG)/World Health Organisation (WHO) gestational diabetes mellitus (GDM) guidelines. As yet there, have been no randomized control trials evaluating the effectiveness of treatment of mild GDM diagnosed under the IADPSG/WHO diagnostic thresholds. We hypothesize that tight glycaemic control in pregnant women diagnosed with GDM will result in similar clinical outcomes to women just below the diagnostic thresholds. Methods: A multiple cut-off regression discontinuity study design in a retrospective observational cohort undergoing oral glucose tolerance tests (OGTT) (n = 1178). Treatment targets for women with GDM were: fasting capillary blood glucose (CBG) of ≤5.0 mmol/L and the 2-h post-prandial CBG of ≤6.7 mmol/L. Regression discontinuity study designs estimate treatment effects by comparing outcomes between a treated group to a counterfactual group just below the diagnostic thresholds with the assumption that covariates are similar. The counterfactual group was selected based on a composite score based on OGTT plasma glucose categories. Results: Women treated for GDM had lower rates of newborns large for gestational age (LGA), 4.6% versus those just below diagnostic thresholds 12.6%, relative risk 0.37 (95% CI, 0.16-0.85); and reduced caesarean section rates, 32.2% versus 43.0%, relative risk 0.75 (95% CI, 0.56-1.01). This was at the expense of increases in induced deliveries, 61.8% versus 39.3%, relative risk 1.57 (95% CI, 1.18-1.9); notations of neonatal hypoglycaemia, 15.8% versus 5.9%, relative risk 2.66 (95% CI, 1.23-5.73); and high insulin usage 61.1%. The subgroup analysis suggested that treatment of women with GDM with BMI ≥30 kg/m2 drove the reduction in caesarean section rates: 32.9% versus 55.9%, relative risk 0.59 (95%CI, 0.4-0.87). Linear regression interaction term effects between non-GDM and treated GDM were significant for LGA newborns (p = 0.001) and caesarean sections (p = 0.015). Conclusions: Tight glycaemic targets reduced rates of LGA newborns and caesarean sections compared to a counterfactual group just below the diagnostic thresholds albeit at the expense of increased rates of neonatal hypoglycaemia, induced deliveries, and high insulin usage.
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Affiliation(s)
- David Song
- Internal Medicine Service, Ballarat Base Hospital, Ballarat, Victoria 3350, Australia;
- Dorevitch Pathology, Chemical Pathology, Melbourne, Victoria 3084, Australia
- School of Medicine, Deakin University, Geelong, Victoria 3217, Australia
| | - James C Hurley
- Internal Medicine Service, Ballarat Base Hospital, Ballarat, Victoria 3350, Australia;
- Department of Rural Health|Melbourne Medical School, University of Melbourne, Ballarat, Victoria 3350, Australia
| | - Maryanne Lia
- Peninsula Health, Melbourne, Victoria 3199, Australia;
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Affiliation(s)
- Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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11
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Jamieson EL, Spry EP, Kirke AB, Atkinson DN, Marley JV. Real-World Gestational Diabetes Screening: Problems with the Oral Glucose Tolerance Test in Rural and Remote Australia. Int J Environ Res Public Health 2019; 16:E4488. [PMID: 31739513 DOI: 10.3390/ijerph16224488] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 01/28/2023]
Abstract
Gestational diabetes mellitus (GDM) is the most common antenatal complication in Australia. All pregnant women are recommended for screening by 75 g oral glucose tolerance test (OGTT). As part of a study to improve screening, 694 women from 27 regional, rural and remote clinics were recruited from 2015–2018 into the Optimisation of Rural Clinical and Haematological Indicators for Diabetes in pregnancy (ORCHID) study. Most routine OGTT samples were analysed more than four hours post fasting collection (median 5.0 h, range 2.3 to 124 h), potentially reducing glucose levels due to glycolysis. In 2019, to assess pre-analytical plasma glucose (PG) instability over time, we evaluated alternative sample handling protocols in a sample of participants. Four extra samples were collected alongside routine room temperature (RT) fluoride-oxalate samples (FLOXRT): study FLOXRT; ice slurry (FLOXICE); RT fluoride-citrate-EDTA (FC Mix), and RT lithium-heparin plasma separation tubes (PST). Time course glucose measurements were then used to estimate glycolysis from ORCHID participants who completed routine OGTT after 24 weeks gestation (n = 501). Adjusting for glycolysis using FLOXICE measurements estimated 62% under-diagnosis of GDM (FLOXRT 10.8% v FLOXICE 28.5% (95% CI, 20.8–29.5%), p < 0.001). FC Mix tubes provided excellent glucose stability but gave slightly higher results (Fasting PG: +0.20 ± 0.05 mmol/L). While providing a realistic alternative to the impractical FLOXICE protocol, direct substitution of FC Mix tubes in clinical practice may require revision of GDM diagnostic thresholds.
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12
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Affiliation(s)
- B Balkau
- CESP Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Paris Sud, Villejuif, France
- European Regional Editor, Diabetic Medicine
| | - R I G Holt
- Human Development and Health, Faculty of Medicine, Medicine, University of Southampton, Southampton, UK
- Editor in Chief, Diabetic Medicine
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