• Mohan, Viswanathan
• Harreiter, Jürgen
• Hibbert, Emily
• Immanuel, Jincy
• Fadl, Helena E.
• Wong, Vincent W. M.
• Group, Tobogm Research
• Nolan, Christopher J.
• Teede, Helena
• Gianatti, Emily J.
• Kautzky-Willer, Alexandra
• Simmons, David
• Hague, William
• Sweeting, Arianne
• Cheung, N. Wah

Abstract

<jats:p>Aim: To compare glycemic test characteristics for predicting GDM at 24-28 weeks’ gestation (LGDM) among those with a normal OGTT &amp;lt;20 weeks’ gestation.</jats:p><jats:p>Methods: Pregnant women with GDM risk factors were enrolled into a multicenter early GDM (EGDM) treatment trial. Women with EGDM are excluded from this analysis. A 2-h 75g OGTT with HbA1c occurred on entry. The OGTT was repeated at 24-28 weeks’ gestation. GDM was defined by WHO 2013 criteria. Receiver Operator Curve (ROC) assessment compared early fasting (FBG), 1-h (1HBG), 2-h (2HBG) glucose and HbA1c prediction of LGDM. ROCs[95%CI] were calculated within European, Asian/Pasifika and other ethnic groups. The proportions with LGDM ≥90th and &amp;lt;90th centile, and their odds ratio (OR [95%CI]) using Mantel-Haenszel testing were calculated for each early glycemic test and a composite of any OGTT measure≥90th centile (F12BG).</jats:p><jats:p>Results: Those with LGDM (n=467) vs no GDM (n=2218) were older (31.4±4.9 vs 30.7±5.1 yrs p=0.009), more likely to be overweight/obese (67.0% vs 57.3% p&amp;lt;0.001), non-European (63.6% vs 57.0% p=0.030) and to have a diabetes family history (52.1% vs 40.7% p&amp;lt;0.001). The ROCs for early FBG, 1HBG, 2HBG, HbA1c were 0.63[0.60-0.66], 0.73[0.70-0.76], 0.66[0.63-0.69], 0.63[0.60-0.66] respectively. ROC patterns were similar across ethnic groups. The ≥90th centile cut-offs (FBG, 1HBG, 2HBG, HbA1c) were ≥4.9 mmol/l, ≥8.8 mmol/l, ≥7.3 mmol/l; ≥5.3% including 11.1%, 10.4%, 10.1%, 15.0% of the cohort. The F12BG composite included 34.0% of the cohort. Comparing ≥90th centile vs &amp;lt;90th centile, LGDM was present in 32.6% vs 15.4%, 47.3% vs 13.9%, 36.4% vs 15.3%, 30.1% vs 14.6%, 35.3% vs 11.4% across the 5 measures with OR of 2.6[2.0-3.4], 5.6[4.3-7.2], 3.2[2.4-4.2], 2.5[2.0-3.2], 4.2[3.4-5.2] respectively. Sensitivities were 21.4%, 28.3%, 21.2%, 27.7%, 50.7% respectively.</jats:p><jats:p>Conclusions: After excluding those with EGDM, the 1HBG was the best single test, but no single or combined early glycemic measure was sufficiently discriminatory to avoid the second OGTT.</jats:p><jats:sec><jats:title>Disclosure</jats:title><jats:p>D. Simmons: Speaker's Bureau; Abbott. Consultant; Sanofi. Speaker's Bureau; Ascensia Diabetes Care. Other Relationship; Ascensia Diabetes Care, Boehringer-Ingelheim. Research Support; Dexcom, Inc. Speaker's Bureau; Novo Nordisk. Research Support; Wests Club, NSW, Australia, Roche Diabetes Care. W. Hague: None. A. Sweeting: None. N. Cheung: None. C.J. Nolan: None. H. Teede: None. M.J. Peek: None. A. Kautzky-Willer: None. E. Hibbert: None. H.E. Fadl: None. V.W.M. Wong: None. J. Harreiter: None. J. Immanuel: None. E.J. Gianatti: None. V. Mohan: None.</jats:p></jats:sec><jats:sec><jats:title>Funding</jats:title><jats:p>National Health and Medical Research Council (grants 1104231 and 2009326), the Region Örebro Research Committee (grants Dnr OLL-970566 and OLL-942177), Medical Scientific Fund of the Mayor of Vienna (project numbers 15205 and 23026), the South Western Sydney Local Health District Academic Unit (grant 2016), and a Western Sydney University Ainsworth Trust Grant (2019).</jats:p></jats:sec>

Topics

• composite
• size-exclusion chromatography
• chemical ionisation