Enhanced glucose processing in gestational diabetes diagnosis: Effects on health equity and clinical outcomes

IF 3.2 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Danielle L. Jones, Laura C. Kusinski, Peter Barker, Keith Burling, Ian Halsall, Elizabeth Turner, Coralie Glenn-Sansum, Abby Rand, Jenny Finch, Genessa Peters, Geraldine Upson, Edward Mullins, Claire L. Meek
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引用次数: 0

Abstract

Objectives

Gestational diabetes is diagnosed using an oral glucose tolerance test (OGTT), which has limited accuracy, reproducibility and practicality. We assessed the effect of enhanced pre-analytical glucose processing upon glucose concentrations, gestational diabetes diagnosis, health equity and pregnancy outcomes, and if HbA1c was a suitable alternative.

Methods

We recruited pregnant women with ≥1 risk factor to a prospective observational cohort study of pregnancy hyperglycaemia, endocrine causes, lipids, insulin and autoimmunity (OPHELIA), from nine UK centres. During a 75 g antenatal OGTT (National Institute of Health and Care Excellence criteria), standard glucose processing was compared to enhanced glucose processing (storage on ice, rapid centrifugation, aliquoting and freezing <2.5 h).

Results

We recruited 1308 participants of mean (SD) age 31.5 years (5.0) and BMI 33.0 kg/m2 (6.8) of 82.5% white ethnicity, representative of the UK population. Enhanced glucose processing resulted in glucose levels ~0.6 mmol/L higher than standard glucose processing, increasing gestational diabetes diagnosis from 9% to 22%. Women with gestational diabetes on enhanced but not standard glucose processing (n = 165) were younger (31.9 vs. 33.2 years, p = 0.035), with a higher BMI (36.5 vs. 33.9 kg/m2; p = 0.003), different ethnic distribution (p = 0.025) and delivered more large-for-gestational age infants (37.0% vs. 22.3%; p = 0.006) compared to women with gestational diabetes on standard processing alone. HbA1c was not a suitable alternative predictor of gestational diabetes diagnosis (Area under receiver operator curve 0.74; 95% CI 0.68–0.79).

Conclusions

An OGTT with enhanced glucose processing would support more accurate, equitable diagnosis of gestational diabetes, but with increased diagnosis rates.

Abstract Image

妊娠期糖尿病诊断中葡萄糖加工增强:对健康公平和临床结果的影响
目的:利用口服葡萄糖耐量试验(OGTT)诊断妊娠糖尿病,其准确性、可重复性和实用性有限。我们评估了强化分析前葡萄糖处理对葡萄糖浓度、妊娠糖尿病诊断、健康公平和妊娠结局的影响,以及HbA1c是否是一种合适的替代方案。方法:我们从9个英国中心招募了风险因素≥1的孕妇进行妊娠高血糖、内分泌原因、血脂、胰岛素和自身免疫(OPHELIA)的前瞻性观察队列研究。在75 g产前OGTT(国家健康与护理卓越标准研究所)期间,将标准葡萄糖处理与强化葡萄糖处理(冰储存、快速离心、ali引用和冷冻)进行比较。结果:我们招募了1308名参与者,平均(SD)年龄31.5岁(5.0),体重指数33.0 kg/m2(6.8),白人占82.5%,代表英国人口。葡萄糖处理增强导致葡萄糖水平比标准葡萄糖处理高0.6 mmol/L,将妊娠糖尿病的诊断率从9%提高到22%。妊娠期糖尿病患者接受强化但非标准葡萄糖处理(n = 165)的女性更年轻(31.9 vs. 33.2岁,p = 0.035), BMI更高(36.5 vs. 33.9 kg/m2;P = 0.003),不同民族分布(P = 0.025),分娩大胎龄儿较多(37.0% vs. 22.3%;P = 0.006),与仅采用标准处理的妊娠期糖尿病妇女相比。糖化血红蛋白(HbA1c)不是妊娠糖尿病诊断的合适替代预测指标(受试者操作曲线下面积0.74;95% ci 0.68-0.79)。结论:加强葡萄糖处理的OGTT将支持更准确、公平的妊娠糖尿病诊断,但诊断率会增加。
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来源期刊
Diabetic Medicine
Diabetic Medicine 医学-内分泌学与代谢
CiteScore
7.20
自引率
5.70%
发文量
229
审稿时长
3-6 weeks
期刊介绍: Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”
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