Real-World Gestational Diabetes Screening: Problems with the Oral Glucose Tolerance Test in Rural and Remote Australia

Emma L. Jamieson, Erica P. Spry, Andrew B. Kirke, David N. Atkinson and Julia V. Marley
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Emma L. Jamieson: The Rural Clinical School of Western Australia, The University of Western Australia, Bunbury 6233, Australia
Erica P. Spry: Kimberley Aboriginal Medical Services, Broome 6725, Australia
Andrew B. Kirke: The Rural Clinical School of Western Australia, The University of Western Australia, Bunbury 6233, Australia
David N. Atkinson: The Rural Clinical School of Western Australia, The University of Western Australia, Broome 6725, Australia
Julia V. Marley: Kimberley Aboriginal Medical Services, Broome 6725, Australia

IJERPH, 2019, vol. 16, issue 22, 1-18

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 (FLOX RT ): study FLOX RT ; ice slurry (FLOX ICE ); 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 FLOX ICE measurements estimated 62% under-diagnosis of GDM (FLOX RT 10.8% v FLOX ICE 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 FLOX ICE protocol, direct substitution of FC Mix tubes in clinical practice may require revision of GDM diagnostic thresholds.

Keywords: gestational diabetes; GDM; oral glucose tolerance test; OGTT; glycolysis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
References: View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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