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  • Publicado : 9 de septiembre de 2012
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Hemoglobin A, versus oral glucose tolerance test in postpartum diabetes screening
Objective – to determine the usefulness of measuring hemoglobin A, (AIC), alone or combined with the fasting glucose test, compared with oral glucose test (OGTT) for the reassessment of the carbohydrate metabolism status in postpartum women with a history of gestational diabetes mellitus (GDM).
Research designand methods – we evaluated the status of carbohydrate metabolism by performing the OGTT and fasting glucose and AIC test in 231 postpartum women with prior GDM 1 year after delivery.
Results – the prevalence of abnormal carbohydrate metabolism was 45.89% by the OGTT criterion, 19.05% by the AIC test criterion, 38.10% by the fasting glucose test criterion, and 46.75% by the AIC – fasting glucosetest criteria. Using the OGTT as the gold standard, abnormal carbohydrate metabolism according to the AIC test criterion had 22.64% sensitivity and 54.55% positive predictive value; abnormal carbohydrate metabolism by the fasting glucose criterion had 83.02% sensitivity and 100% positive predictive value. The AIC – fasting glucose test criteria classified 18 women with normal carbohydratemetabolism as having abnormal carbohydrate metabolism. Abnormal carbohydrate metabolism by the AIC- fasting glucose test criteria had 83.02% sensitivity and 81.48% positive predictive value.
Conclusions – ours results seem to indicate that the AIC test criterion alone or in combination with fasting glucose test criterion does not provide a sensitivity and specific diagnostic of abnormal carbohydratemetabolism in women who have had GDM.
Gestational diabetes mellitus (GDM) is described as any degree of glucose intolerance with onset or first recognition during pregnancy. The prevalence of GDM varies worldwide and among racial and ethnic groups within a country. Variations in prevalence also depend on the method and diagnostic criteria used. According to the international Association ofDiabetes and Pregnancy Study Groups diagnostic criteria, 18% of the women in the world would be diagnosed with diabetes during pregnancy. In Spain, the prevalence of GDM is estimated to be 8.8% according to the National Diabetes Data Group.
Nearly all women with GDM 90% are normoglycemic just after delivery but they are at high risk for abnormal carbohydrate metabolism and recurrent GDM. Therecurrent rate of GDM is successive pregnancies is 35%, increasing risk of developing type 2 diabetes and cardiovascular disease, it is important to reevaluate these women and detect as many cases as possible.
The American College Obstetricians and Gynecologists, the American Diabetes Association (ADA), and the Fifth International workshop-conference on Gestational Diabetes Mellitus recommendlon*g-tem follow-up for women with GDM using 2-h 75-g oral glucose tolerance test (OGTT). This long term follow-up is essential, and reassessment of glycemic status should be undertaken at a minimum of 3 years because a negative postpartum screening test only excludes the presences of type 1 or type 2 diabetes at the time of the rest.
During the last decade, the ADA has updated is screeningrecommendations for abnormal carbohydrate metabolism. Previously to identify patients at high risk for diabetes, the ADA preferred the used of the fasting blood glucose test instead of the ODTT due to it is logical advantages, however, individuals still need to fast for at least 8h before testing. As the hemoglobin A (AIC) test is a nonfasting test, it has signification practical advantages over the OGTT,and it is now becoming the preferred test to diagnose abnormal carbohydrate metabolism. With this background, the purpose of this study was to evaluate the usefulness of AIC (alone or combined with a fasting glucose test) for the reassessment of carbohydrate metabolism status in postpartum women with a history of GDM.
Research design and methods
Subjects
A total of 231 Spanish women with...
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