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A postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo a postnatal oral glucose tolerance test

A postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo a postnatal oral glucose tolerance test
A postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo a postnatal oral glucose tolerance test
Aims It is recommended that women with gestational diabetes (GDM) should have a 6-week postnatal oral glucose tolerance test (OGTT). As this test may be unpleasant, time-consuming and has resource implications, we evaluated whether the 6-week postnatal fasting glucose could be used to determine which women should undergo an OGTT.
Methods All women with GDM, diagnosed according to the World Health Organization criteria, who were delivered at the Princess Anne Hospital, Southampton between May 2000 and May 2002, were recommended to have an OGTT. The results of the fasting plasma glucose concentration were assessed in relation to the 2-h glucose value.
Results One-hundred and fifty-two women with GDM were delivered. Thirty (19.7%) women refused an OGTT or failed to attend. In the 122 OGTTs, three (2.4%; 95% confidence interval 0.8, 7) women had diabetes, three had impaired glucose tolerance and four had impaired fasting glycaemia. No woman with a normal test had fasting glucose of ? 6.0 mmol/l. Fasting glucose was correlated with the 2-h glucose (r = 0.62, P < 0.0001). Only 10 (8.1%) of the OGTTs would have been performed if only women with fasting glucose of ? 6.0 mmol/l underwent the test. The sensitivity and specificity of this approach for the diagnosis of postnatal diabetes is 100% and 94%, respectively. Linear regression methods indicate that it would miss fewer than three in 10 000 cases.
Conclusions In our population, a 6-week postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo an OGTT. Consequently we now perform OGTT only in women whose postnatal fasting plasma glucose is ? 6.0 mmol/l.
0742-3071
594-598
Holt, R.I.G.
d54202e1-fcf6-4a17-a320-9f32d7024393
Goddard, J.R.
25ba9f2f-ded9-4bd6-83cd-332c0c969b26
Clarke, P.
9bf00ed7-b5fb-4b93-9eb7-46449b1ca69d
Coleman, M.A.
f594e23d-e6be-4959-b8c7-52049e91acd6
Holt, R.I.G.
d54202e1-fcf6-4a17-a320-9f32d7024393
Goddard, J.R.
25ba9f2f-ded9-4bd6-83cd-332c0c969b26
Clarke, P.
9bf00ed7-b5fb-4b93-9eb7-46449b1ca69d
Coleman, M.A.
f594e23d-e6be-4959-b8c7-52049e91acd6

Holt, R.I.G., Goddard, J.R., Clarke, P. and Coleman, M.A. (2003) A postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo a postnatal oral glucose tolerance test. Diabetic Medicine, 20 (7), 594-598. (doi:10.1046/j.1464-5491.2003.00974.x).

Record type: Article

Abstract

Aims It is recommended that women with gestational diabetes (GDM) should have a 6-week postnatal oral glucose tolerance test (OGTT). As this test may be unpleasant, time-consuming and has resource implications, we evaluated whether the 6-week postnatal fasting glucose could be used to determine which women should undergo an OGTT.
Methods All women with GDM, diagnosed according to the World Health Organization criteria, who were delivered at the Princess Anne Hospital, Southampton between May 2000 and May 2002, were recommended to have an OGTT. The results of the fasting plasma glucose concentration were assessed in relation to the 2-h glucose value.
Results One-hundred and fifty-two women with GDM were delivered. Thirty (19.7%) women refused an OGTT or failed to attend. In the 122 OGTTs, three (2.4%; 95% confidence interval 0.8, 7) women had diabetes, three had impaired glucose tolerance and four had impaired fasting glycaemia. No woman with a normal test had fasting glucose of ? 6.0 mmol/l. Fasting glucose was correlated with the 2-h glucose (r = 0.62, P < 0.0001). Only 10 (8.1%) of the OGTTs would have been performed if only women with fasting glucose of ? 6.0 mmol/l underwent the test. The sensitivity and specificity of this approach for the diagnosis of postnatal diabetes is 100% and 94%, respectively. Linear regression methods indicate that it would miss fewer than three in 10 000 cases.
Conclusions In our population, a 6-week postnatal fasting plasma glucose is useful in determining which women with gestational diabetes should undergo an OGTT. Consequently we now perform OGTT only in women whose postnatal fasting plasma glucose is ? 6.0 mmol/l.

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Published date: 2003

Identifiers

Local EPrints ID: 25620
URI: http://eprints.soton.ac.uk/id/eprint/25620
ISSN: 0742-3071
PURE UUID: 6c90d354-5c7a-4eed-81bf-847a931700b4
ORCID for R.I.G. Holt: ORCID iD orcid.org/0000-0001-8911-6744

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Date deposited: 20 Apr 2006
Last modified: 16 Mar 2024 03:19

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Author: R.I.G. Holt ORCID iD
Author: J.R. Goddard
Author: P. Clarke
Author: M.A. Coleman

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