PMID- 33636922
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210301
IS  - 2576-9456 (Print)
IS  - 2475-7241 (Linking)
VI  - 3
IP  - 3
DP  - 2018 Nov 1
TI  - Intervention to Reduce Unnecessary Glucose Tolerance Testing in Pregnant Women.
PG  - 418-428
LID - 10.1373/jalm.2018.026047 [doi]
AB  - BACKGROUND: Gestational diabetes mellitus (GDM) can be diagnosed in pregnant 
      women by increased fasting plasma glucose alone, which eliminates the need for 
      performing a 75 g oral glucose tolerance test (OGTT). If whole blood glucose 
      meters are used to triage fasting samples in order to decide whether to give the 
      glucose drink, a cutpoint with appropriate sensitivity and specificity for 
      elevated fasting plasma glucose is needed. METHODS: The number of GDM diagnoses 
      by increased fasting plasma glucose alone was determined from specimens collected 
      and tested at core laboratories in urban hospitals, rural health centers, and 
      from specimens collected at patient phlebotomy service centers (PSCs) for plasma 
      testing at a central laboratory. The number of glucose drinks avoided was counted 
      after implementing the diagnostic cutoff of >/=95 mg/dL (5.3 mmol/L) at urban 
      hospitals and rural health centers, which have on-site plasma testing, and after 
      selecting a PSC meter fasting venous whole blood glucose cutpoint after 
      calculating sensitivity and specificity for plasma glucose >/=95 mg/dL (5.3 mmol/L) 
      using logistic regression. RESULTS: Among 4850 OGTTs, there were 1315 GDM 
      diagnoses annually, of which 409 were from increased fasting plasma glucose. 
      Ninety-one percent of OGTTs were performed at PSCs. If a fasting plasma glucose 
      cutpoint of >/=95 mg/dL (5.3 mmol/L) was implemented at urban hospitals and rural 
      health centers and a meter fasting venous whole blood glucose cutpoint of >/=108 
      mg/dL (6.0 mmol/L) (25% sensitivity, 99.9% specificity) was implemented at PSCs, 
      the drink would be appropriately avoided by 145 patients/year, and 
      inappropriately avoided by 3 patients/year. After implementing these cutpoints, 
      the drink was appropriately avoided in 91 patients during a 36-week period, with 
      none inappropriately avoiding it. CONCLUSION: Modifying fasting glucose cutpoints 
      reduced unnecessary diagnostic OGTTs in pregnant women.
CI  - (c) 2018 American Association for Clinical Chemistry.
FAU - Buse, Joshua D
AU  - Buse JD
AD  - Department of Analytical Toxicology, Calgary Laboratory Services, Calgary, AB, 
      Canada.
AD  - Department of Pathology and Laboratory Medicine, Cumming School of Medicine, 
      University of Calgary, Calgary, AB, Canada.
FAU - Donovan, Lois E
AU  - Donovan LE
AD  - Diabetes in Pregnancy Clinic, Calgary Zone, Alberta Health Services Division of 
      Endocrinology and Metabolism, and the Department of Obstetrics and Gynecology, 
      Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
FAU - Naugler, Christopher T
AU  - Naugler CT
AD  - Department of Pathology and Laboratory Medicine, Cumming School of Medicine, 
      University of Calgary, Calgary, AB, Canada.
FAU - Sadrzadeh, S M Hossein
AU  - Sadrzadeh SMH
AD  - Department of Analytical Toxicology, Calgary Laboratory Services, Calgary, AB, 
      Canada.
AD  - Department of Pathology and Laboratory Medicine, Cumming School of Medicine, 
      University of Calgary, Calgary, AB, Canada.
FAU - de Koning, Lawrence
AU  - de Koning L
AD  - Department of Pathology and Laboratory Medicine, Cumming School of Medicine, 
      University of Calgary, Calgary, AB, Canada.
LA  - eng
PT  - Journal Article
PL  - England
TA  - J Appl Lab Med
JT  - The journal of applied laboratory medicine
JID - 101693884
SB  - IM
EDAT- 2018/11/01 00:00
MHDA- 2018/11/01 00:01
CRDT- 2021/02/27 01:01
PHST- 2018/01/15 00:00 [received]
PHST- 2018/05/04 00:00 [accepted]
PHST- 2021/02/27 01:01 [entrez]
PHST- 2018/11/01 00:00 [pubmed]
PHST- 2018/11/01 00:01 [medline]
AID - 5603129 [pii]
AID - 10.1373/jalm.2018.026047 [doi]
PST - ppublish
SO  - J Appl Lab Med. 2018 Nov 1;3(3):418-428. doi: 10.1373/jalm.2018.026047.