Can single plasma glucose value 2 hours after 75g glucose (DIPSI criteria) replace the gold standard OGTT for the diagnosis of gestational diabetes mellitus?

Neeraj Sharma; Seema Pundir; Bunty Dinani

doi:10.18203/2320-1770.ijrcog20190877

Authors

Neeraj Sharma Department of Obstetrics and Gynecology, Dr. Baba Saheb Ambedkar Hospital, New Delhi, India
Seema Pundir Department of Obstetrics and Gynecology, Dr. Baba Saheb Ambedkar Hospital, New Delhi, India
Bunty Dinani Department of Obstetrics and Gynecology, Dr. Baba Saheb Ambedkar Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20190877

Keywords:

DIPSI, GDM, IADPSG, OGTT, OPD

Abstract

Background: Gestational diabetes mellitus is a common medical complication of pregnancy associated with several fetal and maternal complications. There are several screening tools for detecting gestational diabetes mellitus including recent DIPSI criteria of non-fasting single plasma 2-hour value after 75 grams glucose (single step test). The present study was aimed at calculating prevalence of GDM, sensitivity and specificity using non-fasting single plasma 2-hour value after 75 grams glucose for screening and diagnosis of gestational diabetes mellitus and to study the high-risk characteristics for GDM in this study population.

Methods: This was a prospective study conducted for a period of one year. 750 antenatal women attending Antenatal outpatient department(OPD) with period of gestation 24-28 weeks were enrolled in the study. All women were first tested by 75 gm glucose and then by OGTT for confirmation. Prevalence rates, sensitivity, specificity, positive predictive value and negative predictive value were studied. History based questionnaire was used to study the risk characteristics for GDM.

Results: Prevalence rate, sensitivity, specificity, positive predictive value and negative predictive value for patients were 14.13%, 73.58%, 95.03%, 70.90% and 95.67%. Among the risk factors 7.2% patients were more than 30 years in age. 0.93% had GDM in previous pregnancy.4.21% had GCA in previous pregnancy, 12.4% had SB/IUD/NND in previous pregnancy. 1.17% had previous pregnancy with birth weight more than 3.5 kg and 9.73% had family history of diabetes mellitus. Past history of GDM (50%) was the most common risk factor in GDM group followed by age > 30 years (29.6%), and family history (24.6%).

Conclusions: Screening using DIPSI criteria has good sensitivity and negative predictive values. It can serve as both screening and diagnostic test besides being simple, user friendly, cost effective and evidence-based test in less resource countries like India.

Metrics

Metrics Loading ...

References

Diagnosis and Management of Gestational Diabetes Mellitus, Feb 2018. Available at http://nhm.gov.in/New_Updates_2018/NHM_Components/RMNCH_MH_Guidelines/Gestational-Diabetes-Mellitus.

ADA. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2009;32:S62-7.

Gabbe SG, Niebyl JR, Simpson JL. Obstetrics: Normal and Problem Pregnancies. New York: Churchill Livingstone; 2002.

Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet. 2015;131:173-211.

Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Kapur A. Pregnancy and diabetes scenario around the world: India. Int J Gynaecol Obstet. 2009;104:S35-8.

Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. NICE guideline.

National Diabetes Data Group (US), National Institute of Diabetes, Digestive, Kidney Diseases (US). Diabetes in America. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1995.

Anjalakshi C, Balaji V, Balaji MS, Ashalata S, Suganthi S, Arthi T, et al. A single test procedure to diagnose gestational diabetes mellitus. Acta Diabetol. 2009;46(1):51-4.

American Diabetes Association: Gestational diabetes mellitus. Diabetes Care. 2004;27(1):S88-90.

Rajput R, Yadav Y, Nanda S, et al. Prevalence of gestational diabetes mellitus and associated risk factors at tertiary care hospital in Haryana. Indian J Med Res. 2013;137(4):728-33.

Seshiah V, Balaji V, Balaji MS, Sanjeevi CB, Green A. Gestational diabetes mellitus in India. Japi. 2004;52:707-11.

Das V, Kamra S, Mishra A, Agarwal A, Agarwal CG. Screening for gestational diabetes and maternal and fetal outcome. J Obstet Gynaecol Ind. 2004;54(5):449-51.

Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Arthi T, Thamizharasi M, Datta M. Prevalence of gestational diabetes mellitus in South India (Tamil Nadu): a community-based study. JAPI. 2008;56:329-3.

Seshiah V, Balaji V, Shah SN, Joshi S, Das AK, Sahay BK, et al. Diagnosis of gestational diabetes mellitus in the community. J Assoc Physicians India. 2012;60:15-7.

Mohan V, Mahalakshmi MM, Bhavadharini B, Maheswari K, Kalaiyarasi G, Anjana RM et al. Comparison of screening for gestational diabetes mellitus by oral glucose tolerance tests done in the non-fasting (random) and fasting states. Acta diabetologica. 2014;51(6):1007-13.

Lapolla A, Dalfrà MG, Ragazzi E, De Cata AP, Fedele D. et al. New IADPSG recommendations for diagnosing gestational diabetes compared with former criteria: a retrospective study on pregnancy outcome. Diab Med. 2011;28(9):1074-7.

Wery E, Vamberque A, Le Goueff F, et al. Impact of the new screening criteria on the gestational diabetes prevalence. J Gynecol Obstet Biol Reprod. (Paris) 2014;43(4):307-13.

Dixon DRD, Winter JTV, Nelson RL, Ogburn PL Jr. Universal versus selective selective diabetes screening: application of American Diabetes Association Recommendations. Am J Obstet Gynecol. 1999;181(4):798-802.

Jindal A, Ahmed F, Bhardwaj B, Chaturvedi B. Prevalence, clinical profile and outcome of gestational diabetes mellitus. J Obst Gyn India. 2001;30:333.

Anand M, Anand M, Mahajan DS. To study the incidence of gestational diabetes mellitus and risk factors associated with GDM. Int J Adv Med. 2017;4(1):112-16.