Comparison of glucose polymer and glucose for screening and tolerance tests in pregnancy. Carbohydrate sources for gestational diabetes mellitus screening. A comparison. Diagnosis of gestational diabetes mellitus in Nigerian pregnant women--comparison between 75G and 100G oral glucose tolerance tests. Screening for gestational diabetes mellitus: comparison of a glucose polymer and a glucose monomer test beverage.
Forty-eight of 100 pregnant women received a 100-g (nonfasting) glucose screening test at about 28 weeks' gestation, followed by a 100-g glucose tolerance test. Another 52 received a 100-g (nonfasting) glucose polymer screening test followed by a 100-g glucose polymer tolerance test. Mean plasma glucose one hour after the glucose screening test was significantly lower than after the glucose polymer screening test. A further 178 women received a glucose polymer screening test and a glucose polymer tolerance test (230 in total). These women and the infants they delivered were studied to derive diagnostic criteria for the 100-g glucose polymer tolerance test by correlating maternal carbohydrate tolerance with indexes of neonatal metabolic performance, and to determine an adequate method of screening for carbohydrate intolerance of pregnancy (gestational diabetes). Diagnostic criteria similar to those of O'Sullivan and Mahan were also developed for the glucose polymer tolerance test. These values are up to 5% lower than those recommended by the National Diabetes Data Group (1979) for the 100-g glucose tolerance test. One hundred eight patients were prospectively randomized to receive 50 g of a glucose polymer, d-glucose or a candy bar during a one-hour gestational diabetes mellitus (GDM) screening. The polymer had a mean serum glucose similar to that of d-glucose, with significantly fewer side effects, allowing an increased rate of examination completion. The candy bar produced a significantly lower mean serum glucose but had the highest rating for flavor. The polymer was an inexpensive and well-tolerated alternative for GDM screening, while the use of a candy bar needs more study. To compare the diagnostic performances of 75g and 100g oral glucose tolerance tests in detecting Gestational Diabetes Mellitus in Nigerian pregnant women.
                248 women in 3rd trimester attending antenatal clinic of the Lagos University Teaching Hospital, Lagos, between November 1997 and July 1999 were randomly subjected to standard oral glucose tolerance tests (OGTT). 110 had 100g OGTT while 138 had 75g OGTT. The plasma glucose response (PGR) was assessed and glucose tolerance status of each patient was determined using WHO (1985) criteria to interpret 75g OGTT and National Diabetes Data Group (NDDG) (1979) criteria for 100g OGTT. The PGR in the two study groups were compared. The prevalence rates of GDM using either of the two criteria were evaluated and compared. Incidences of foetal macrosomia in GDM cases diagnosed by either set of criteria were also compared.
                The mean age of the study subjects was 30.7(+/-4.2) years while the BMI was 25.4(+/-4.9) kg/m2. The mean parity was 1.33. Traditional risk factors for GDM were found in 47.5% of them. The plasma glucose response (PGR) to 100g OGTT was found to be higher than that of 75g OGTT at 1 hour, 2hour and 3 hour sampling times but the difference was only significant at 3rd hour (p values = 0.68, 0.137, 0.007 respectively). The total area under the glucose response curve (AUC) for 75g OGTT was 345.1 (+/-49.5) AAU while for 100g OGTT, it was 363.4(+/-61.4) AAU. The difference was not statistically significant (p value >0.05). The prevalence rate of GDM diagnosed by 75g OGTT was 11.6% while that of 100g OGTT was 4.5 %. The difference was significant (p value = 0.04). The incidence rate of foetal macrosomia among GDM cases diagnosed by 100g OGTT was 66.7% as against 23.1% among those diagnosed by 75g OGTT. Statistical difference could not be determined because of the small number.
                Plasma glucose response to OGTT among Nigerian pregnant women has little or no respect for the load of the glucose administered. 100g OGTT- based NDDG criteria was more stringent than 75g OGTT-based WHO criteria in identifying GDM. However it appears to be more specific for detecting the complications associated with the condition though it will require a larger study to validate this claim. The current test for gestational diabetes mellitus (GDM) uses a glucose monomer test beverage, which frequently causes gastrointestinal symptoms, and venipuncture. We investigated a simplified test using a beverage of glucose polymer and a capillary whole blood glucose measurement.
                In a randomized, double-blind clinical trial, women at 24 to 28 weeks' gestation received a 50-g glucose monomer (n = 41) or glucose polymer (n = 35) beverage. Venous and capillary blood samples were obtained 1 hour later. The women then completed standardized questionnaires about their symptoms.
                The glucose polymer beverage was associated with significantly fewer symptoms than was the glucose monomer drink: the mean was 1.1 symptoms per test with the glucose monomer drink and 0.4 symptoms per test with the glucose polymer drink (P less than 0.05), 51 percent of the women developed symptoms after drinking the glucose monomer beverage, and 27 percent of the women developed symptoms after drinking the glucose polymer beverage (P less than 0.05). Glucose type did not affect the 1-hour plasma glucose level, mean 5.94 mmol/L (107 mg/dL) for the glucose monomer and 5.76 mmol/L (103.8 mg/dL) for the glucose polymer (P = 0.79). For the capillary test, sensitivity was 0.75 and specificity was 0.82 in detecting a screening test positive by the venous plasma glucose criterion.
                The results of this study indicate that a glucose polymer beverage is better tolerated than a glucose monomer beverage during GDM screening, but capillary glucose measurement might be of limited use in clinics where many personnel perform the capillary blood glucose testing.
There is insufficient evidence to assess which is the best strategy for diagnosing GDM.