Performance of Different Glucose Testing Methods Amongst Patients of Gestational Diabetes Mellitus in St. Francis Hospital Nsambya, Kampala, Uganda: A CrossSectional and Descriptive Study

Abstract

Background: Medical examination detects illness or disease risk factors in individuals otherwise well to treat early on and minimize morbidity and death. In spite of recommended GDM screening during prenatal care worldwide and local standards, it has been shown that the procedure has not been properly implemented. A further difficulty might be the lack of consensus worldwide and on local consistence on GDM screening and diagnosis guidelines. Methods: The study was a hospital based cross-sectional and descriptive study that employed both quantitative and qualitative methods of data collection. A descriptive study was concerned with describing the characteristics of a particular individual, or of a group in a given situation. The study was guided by the primary objective of assessing the extent of GDM monitoring among women receiving antenatal care at St. Francis Hospital Nsambya in Kampala, Uganda. Both Capillary and venous blood samples in which plasma/serum was taken from pregnant mothers and their glucose levels estimated using a One touch (Roche Diagnostics) code 298 and plasma calibrated glucometer and Roche Cobas C311fully automated Chemistry Analyser respectively. Both whole blood glucose and plasma/serum glucose was determined as per the principle of enzyme hexokinase (HK) catalyzes the reaction between glucose and adenosine triphosphate (ATP) to form glucose-6-phosphate (G-6-P) and adenosine diphosphate (ADP). In the presence of nicotinamide adenine dinucleotide (NAD), G-6-P is oxidized by the enzyme glucose-6-phosphate Dehydrogenase (G-6-PD) to 6-phosphogluconate and reduced nicotinamide adenine dinucleotide (NADH). The increase in NADH concentration was directly proportional to the glucose concentration and was measured spectrophotometrically at 340 nm. The data was analysed using the McNemar's test to determine the sensitivity, specificity and the direct cost for performing capillary glucose. Receiver operator characteristic and Area under curve analyses to analyze the predictive power of the constructed equation Sensitivity, specificity, false positive rate and false negative rate was computed to validate the capillary method in testing/detecting Gestational Diabetes Mellitus. Data analysis was performed using the SPSS package Results: The results presented below for both capillary and Venous Blood Glucose were based on the principle of glucose oxidase test. Cutoff for the different blood sugar level were as follows; Normal A1C test being < 5.4% and Diabetes being >5.4%. Based on the Venous Blood Glucose tests method, 89.0% (154/173) respondents tested normal, while 11.0% (19/173) had diabetes. However, capillary blood glucose testing method identified 78.6% (136/173)5 respondents as being normal compared 21.4% (37/173) having diabetes. Results obtained from the process indicate capillary glucose blood test for gestation diabetes having very low sensitivity i.e. 30% for gestation diabetes. The findings of the study will help to create public awareness on disease burden, improved diagnosis, classification, management and health policies by the Ministry of Health about Gestational diabetes among Ugandan mothers. Conclusion: Most of the procedures employed to detect and trace for GDM was found to be painful and stressful. The healthcare providers and managers some lacked required skills and knowledge concerning GDM among women and procedural handling was found to be wanting in one case or another. The GDM prevalence was discovered to be slowly increasing even though it was detected to be at low levels at Nsambya hospital but the situation elsewhere might be different. Most of the GDM risk factors were majorly originating from family background, maternal ages discrepancies, and abuse of alcohol. Most GDM challenges were found to be fueled by lack of proper counseling and screening since it wasn’t routine among health care professionals hence lack of expertise and inconsistencies in handling GDM women. Preparing women for GDM screening and diagnosis would have reduced the risks and health challenges faced by pregnant women if they are well prepared and trained before subjecting them to the GDM testing.