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A retrospective analysis of the results of 100 gr oral glucose tolerans test among the pregnant patients whose 50 gr glucose challenge test were positive

Year 2010, Volume: 41 Issue: 3, 123 - 127, 01.04.2010

Abstract

Objective: To determine a cut-off value on the 50 gr glucose challenge test (GCT) for the diagnosis of gestational diabetes mellitus (GDM). Materials and Methods: Ninety five pregnant patients whose 50 gr GCT are positive were included in this retrospective trial. OGTT was administered after one week to these patients. The findings were evaluated based on the test results. Results: Fifty eigth of ninety five patients (61.1%) patients got GDM diagnosis according to their OGTT results. Thirty seven of this ninety five (38.9%) patients were accepted as a normal based on OGTT results. In normal group , the mean of the GCT results was 155.8±9.3 mg/dl, in GDM group, the mean of the GCT results was 165.8±14.7 mg/dl (p=0.001). If the level of 140 mg/dl was accepted as a cut-off value for the diagnosis of GDM, sensitivity was 86% and spesifity was 19%. But when the cut-off level increased to 200 mg/dl, sensitivity decreased to 5%, spesifity increased to 100%. Conclusion: Diagnosis of GDM cannot be made just only with a certain cut-off level on GCT. Currently, it looks that two step evaluation with GCT and OGTT is most suitable and acceptable way to determine GDM in pregnancy.

References

  • 1. Lain KY, Catalano PM. Metabolic changes in pregnancy. Clin Obstet Gynecol 2007;50(4):938-948
  • 2. American Diabetes Assosiation: Gestational diabetes mellitus (Position Statement). Diabetes Care 2004;27 (Suppl. 1):S88-S90
  • 3. Karcaaltincaba D, Kandemir O, Yalvaç S, Guvendag-Guven S, Haber al A. Prevalence of gestational diabetes mellitus and gestational impaired glucose tolerance in pregnant women evaluated by National Diabetes Data Group and Carpenter and Coustan criteria. Int J Gynaecol Obstet. 2009; 106:246-249
  • 4. American College of Obstetricians and Gynecologists (ACOG), Committee on Practice Bulletins - Obstetrics. Clinical Management Guidelinesfor Obstetricians- Gynecologists. ACOG Practice Bulletin No. 30. Washington, DC: ACOG, 2001
  • 5. Brody SC, Harris R, Lohr K. Screening for gestational diabetes: a summary of the evidence for the US Preventive Services Task Force. Obstet Gynecol 2003,101: 380-92
  • 6. Lanni SM, Barrett DP. The predictive value of the 1-h 50-g glucose screen for diagnosing gestational diabetes mellitus in a highrisk population. The Journal of Maternal-Fetal and Neonatal Medicine 2004;15:375-379
  • 7. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982;144(7):768-73
  • 8. Moore TR. Diabetes in pregnancy. In Creasy R, ResnickR, eds. Maternal Fetal Medicine, 4th edn. Philadelphia, PA: WB Saunders Company, 1999:964-95
  • 9. Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee, Diabetes Care 1998;21(Suppl. 2):B161-B167
  • 10. American College of Obstetricians and Gynecologists: Diabetes and Pregnancy, Technical Bulletin No. 200, December 1994
  • 11. Hanna FWF, Peters JR. Screening for gestational diabetes; past, present and future. Diabetic Med 2002; 19:351-358
  • 12. Davidson MB. Counterpoint: the oral glucose tolerance test is superfluous. Diabetes Care2002;25:1883-1885
  • 13. Tuomilehto J. Point: a glucose tolerance test is important for clinical practice. Diabetes Care 2002; 25:1880-1882
  • 14. Agarwal MM, Punnose J, Dhatt GS (2004) Gestational diabetes: problems associated with the oral glucose tolerance lest. Diabetes Res Clin Pract63:73-74
  • 15. Miyakoshi K, Tanaka M, Ueno K, Uehara K, Ishimoto H, Yoshimura Y. Cutoff value of 1 h, 50 g glucose challenge testfor screening of gestational diabetes mellitus in a Japanese population. Diabet Research Clin Pract 2003;60:63-67
  • 16. Jang HJ, Cho NH, Jung KB, Oh KS, Dooley SL, Metzger BL. Screening for gestational diabetes mellitus in Korea. Int J Gynaecol Obstet 1995;51:115-122
  • 17. Yalcin HR, Zorlu CG. Threshold value of glucose screening tests in pregnancy: could it be standardizedfor every population? Am J Perinatol 1996,1996:13:317-320
  • 18. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979; 28:1039-1057
  • 19. Friedman S, Khoury-Collado F, Dalloul M, Sherer DM, Abulafia O. Glucose challenge test threshold values in screening for gestational diabetes among black women. Am J Obstet Gynecol 2006; 194: e46-48
  • 20. Chandna A, Zuberi LM, Munim S. Threshold values for the glucose challenge test in pregnancy. Int J Gynaecol Obstet 2006;94: 119-120
  • 21. Poyhonen-Alho MK, Teramo KA, Kaaja RJ, Hiilesmaa VK. 50 gram oral glucose challenge test combined with riskfactor-based screening for gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2005;121:34-37
  • 22. Nahum GG, Huffaker BJ. Racial differences in oral glucose screening test results: establishing race-specific criteria for abnormality in pregnancy. Obstet Gynecol 1993;81:517-522
  • 23. Brody SC, Harris R, Lohr K. Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force. Obstet Gynecol 2003; 101: 380-392
  • 24. Dudhbhai M, Lim L, Bombard A, et al. Characteristics of patients with abnormal glucose challenge test and normal oral glucose tolerance test results: comparison with normal and gestational diabetic patients. Am J Obstet Gynecol 2006,194: e42-e45
  • 25. Montagnana M, Lippi G, Targher G, Fava C, Cesare Guid C. Glucose Challenge Test Does not Predict Gestational Diabetes Mellitus. Inter Med 2008;47:1171-1174

Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi

Year 2010, Volume: 41 Issue: 3, 123 - 127, 01.04.2010

Abstract

Amaç: Gestasyonel diabet (GDM) tanısı koymak için 1 saatlik 50 gr glukoz tarama testinde (Glucose Challenge Test-GCT) bir eşik değer belirlemek. Materyal ve Metod: Bu retrospektif çalışmaya glukoz tarama testi pozitif çıkan 95 gebe dahil edildi. Bu gruba 1 hafta sonra 100 gr oral glukoz tolerans testi (OGTT) uygulandı. Test sonucuna gore diabet tanısı alan ve almayan hastaların verileri üzerinde kıyaslama yapıldı. Bulgular: Bu 95 gebenin 58'inde (%61.1) OGTT sonucu da pozitif olarak geldi ve GDM tanısı aldılar. Sonucu pozitif olduğu halde OGTT tahlili normal olanların oranı ise %38.9 (37/95) idi. Normal gebelerin GCT değer ortalaması 155.8±9.3 mg/dl, GDM grubunun ise 165.8±14.7 mg/dl idi (p=0.001). GCT eşik değeri 140 mg/dl alındığında sensitivite %86 iken spesifisite %19 e düşmekte idi. Eşik değer 200 mg/dl olarak kabul edildiğinde ise sensitivite %5, spesifisite ise %100 idi. Sonuç: GDM tanısı sadece GCT deki tek bir eşik değer göre konulamaz. Günümüzde hala GDM tanısının iki basamaklı GCT ve OGTT ile yapılması en uygun program gibi görülmektedir.

References

  • 1. Lain KY, Catalano PM. Metabolic changes in pregnancy. Clin Obstet Gynecol 2007;50(4):938-948
  • 2. American Diabetes Assosiation: Gestational diabetes mellitus (Position Statement). Diabetes Care 2004;27 (Suppl. 1):S88-S90
  • 3. Karcaaltincaba D, Kandemir O, Yalvaç S, Guvendag-Guven S, Haber al A. Prevalence of gestational diabetes mellitus and gestational impaired glucose tolerance in pregnant women evaluated by National Diabetes Data Group and Carpenter and Coustan criteria. Int J Gynaecol Obstet. 2009; 106:246-249
  • 4. American College of Obstetricians and Gynecologists (ACOG), Committee on Practice Bulletins - Obstetrics. Clinical Management Guidelinesfor Obstetricians- Gynecologists. ACOG Practice Bulletin No. 30. Washington, DC: ACOG, 2001
  • 5. Brody SC, Harris R, Lohr K. Screening for gestational diabetes: a summary of the evidence for the US Preventive Services Task Force. Obstet Gynecol 2003,101: 380-92
  • 6. Lanni SM, Barrett DP. The predictive value of the 1-h 50-g glucose screen for diagnosing gestational diabetes mellitus in a highrisk population. The Journal of Maternal-Fetal and Neonatal Medicine 2004;15:375-379
  • 7. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982;144(7):768-73
  • 8. Moore TR. Diabetes in pregnancy. In Creasy R, ResnickR, eds. Maternal Fetal Medicine, 4th edn. Philadelphia, PA: WB Saunders Company, 1999:964-95
  • 9. Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee, Diabetes Care 1998;21(Suppl. 2):B161-B167
  • 10. American College of Obstetricians and Gynecologists: Diabetes and Pregnancy, Technical Bulletin No. 200, December 1994
  • 11. Hanna FWF, Peters JR. Screening for gestational diabetes; past, present and future. Diabetic Med 2002; 19:351-358
  • 12. Davidson MB. Counterpoint: the oral glucose tolerance test is superfluous. Diabetes Care2002;25:1883-1885
  • 13. Tuomilehto J. Point: a glucose tolerance test is important for clinical practice. Diabetes Care 2002; 25:1880-1882
  • 14. Agarwal MM, Punnose J, Dhatt GS (2004) Gestational diabetes: problems associated with the oral glucose tolerance lest. Diabetes Res Clin Pract63:73-74
  • 15. Miyakoshi K, Tanaka M, Ueno K, Uehara K, Ishimoto H, Yoshimura Y. Cutoff value of 1 h, 50 g glucose challenge testfor screening of gestational diabetes mellitus in a Japanese population. Diabet Research Clin Pract 2003;60:63-67
  • 16. Jang HJ, Cho NH, Jung KB, Oh KS, Dooley SL, Metzger BL. Screening for gestational diabetes mellitus in Korea. Int J Gynaecol Obstet 1995;51:115-122
  • 17. Yalcin HR, Zorlu CG. Threshold value of glucose screening tests in pregnancy: could it be standardizedfor every population? Am J Perinatol 1996,1996:13:317-320
  • 18. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979; 28:1039-1057
  • 19. Friedman S, Khoury-Collado F, Dalloul M, Sherer DM, Abulafia O. Glucose challenge test threshold values in screening for gestational diabetes among black women. Am J Obstet Gynecol 2006; 194: e46-48
  • 20. Chandna A, Zuberi LM, Munim S. Threshold values for the glucose challenge test in pregnancy. Int J Gynaecol Obstet 2006;94: 119-120
  • 21. Poyhonen-Alho MK, Teramo KA, Kaaja RJ, Hiilesmaa VK. 50 gram oral glucose challenge test combined with riskfactor-based screening for gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2005;121:34-37
  • 22. Nahum GG, Huffaker BJ. Racial differences in oral glucose screening test results: establishing race-specific criteria for abnormality in pregnancy. Obstet Gynecol 1993;81:517-522
  • 23. Brody SC, Harris R, Lohr K. Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force. Obstet Gynecol 2003; 101: 380-392
  • 24. Dudhbhai M, Lim L, Bombard A, et al. Characteristics of patients with abnormal glucose challenge test and normal oral glucose tolerance test results: comparison with normal and gestational diabetic patients. Am J Obstet Gynecol 2006,194: e42-e45
  • 25. Montagnana M, Lippi G, Targher G, Fava C, Cesare Guid C. Glucose Challenge Test Does not Predict Gestational Diabetes Mellitus. Inter Med 2008;47:1171-1174
There are 25 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Gazi Yıldırım This is me

Canan Yılmaz This is me

Fırat Ersan This is me

Rukset Attar This is me

Aslı Somunkıran This is me

Narter Yeşildağlar This is me

Ateş Karateke This is me

D. Cem Fıçıcıoğlu This is me

Publication Date April 1, 2010
Published in Issue Year 2010 Volume: 41 Issue: 3

Cite

APA Yıldırım, G., Yılmaz, C., Ersan, F., Attar, R., et al. (2010). Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi. Zeynep Kamil Tıp Bülteni, 41(3), 123-127. https://doi.org/10.16948/zktb.91307
AMA Yıldırım G, Yılmaz C, Ersan F, Attar R, Somunkıran A, Yeşildağlar N, Karateke A, Fıçıcıoğlu DC. Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi. Zeynep Kamil Tıp Bülteni. April 2010;41(3):123-127. doi:10.16948/zktb.91307
Chicago Yıldırım, Gazi, Canan Yılmaz, Fırat Ersan, Rukset Attar, Aslı Somunkıran, Narter Yeşildağlar, Ateş Karateke, and D. Cem Fıçıcıoğlu. “Gebelik sırasında 50 Gr Glukoz Tarama Testi Pozitif Olan hastaların 100 Gr Oral Glukoz Tolerans Testi sonuçlarının Retrospektif Olarak değerlendirilmesi”. Zeynep Kamil Tıp Bülteni 41, no. 3 (April 2010): 123-27. https://doi.org/10.16948/zktb.91307.
EndNote Yıldırım G, Yılmaz C, Ersan F, Attar R, Somunkıran A, Yeşildağlar N, Karateke A, Fıçıcıoğlu DC (April 1, 2010) Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi. Zeynep Kamil Tıp Bülteni 41 3 123–127.
IEEE G. Yıldırım, C. Yılmaz, F. Ersan, R. Attar, A. Somunkıran, N. Yeşildağlar, A. Karateke, and D. C. Fıçıcıoğlu, “Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi”, Zeynep Kamil Tıp Bülteni, vol. 41, no. 3, pp. 123–127, 2010, doi: 10.16948/zktb.91307.
ISNAD Yıldırım, Gazi et al. “Gebelik sırasında 50 Gr Glukoz Tarama Testi Pozitif Olan hastaların 100 Gr Oral Glukoz Tolerans Testi sonuçlarının Retrospektif Olarak değerlendirilmesi”. Zeynep Kamil Tıp Bülteni 41/3 (April 2010), 123-127. https://doi.org/10.16948/zktb.91307.
JAMA Yıldırım G, Yılmaz C, Ersan F, Attar R, Somunkıran A, Yeşildağlar N, Karateke A, Fıçıcıoğlu DC. Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi. Zeynep Kamil Tıp Bülteni. 2010;41:123–127.
MLA Yıldırım, Gazi et al. “Gebelik sırasında 50 Gr Glukoz Tarama Testi Pozitif Olan hastaların 100 Gr Oral Glukoz Tolerans Testi sonuçlarının Retrospektif Olarak değerlendirilmesi”. Zeynep Kamil Tıp Bülteni, vol. 41, no. 3, 2010, pp. 123-7, doi:10.16948/zktb.91307.
Vancouver Yıldırım G, Yılmaz C, Ersan F, Attar R, Somunkıran A, Yeşildağlar N, Karateke A, Fıçıcıoğlu DC. Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi. Zeynep Kamil Tıp Bülteni. 2010;41(3):123-7.