title: Comparison of screening for gestational diabetes mellitus by oral glucose tolerance tests done in the non-fasting (random) and fasting states.
abstract: OBJECTIVE
  The Diabetes in Pregnancy Study Group of India (DIPSI) guidelines recommend the non-fasting 75-g oral glucose tolerance test (OGTT) as a single-step screening and diagnostic test for gestational diabetes mellitus (GDM). The aim of this study was to compare the DIPSI criteria with the World Health Organization (WHO) 1999 and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for GDM.
  
  
  METHODS
  A total of 1,031 pregnant women attending antenatal clinics in urban and rural Tamil Nadu, India, underwent a 75-g OGTT in both non-fasting and fasting states, 2-3 days apart. Venous plasma glucose was measured using an autoanalyser, and GDM was diagnosed by DIPSI, WHO 1999 and IADPSG criteria.
  
  
  RESULTS
  Of the 83 women identified to have GDM by WHO 1999 criteria, only 23 were diagnosed by DIPSI criteria. Of the 106 women diagnosed to have GDM by the IADPSG criteria, only 24 were diagnosed by DIPSI. The DIPSI non-fasting OGTT 2-h VPG cut point of 140 mg/dl (7.8 mmol/l) had a very low sensitivity when compared to the WHO 1999 criteria (sensitivity 27.7 %, specificity 97.7 %) and IADPSG criteria (sensitivity 22.6 %, specificity 97.8 %).
  
  
  CONCLUSIONS
  The DIPSI non-fasting OGTT criteria cannot be recommended for diagnosis of GDM due to its low sensitivity. Thus, as a single-step diagnostic test for GDM, the fasting OGTT needs to be done. When this is not possible, the well-established two-step procedure using the 50-g glucose challenge test as an initial screening test, followed by the diagnostic fasting OGTT, can be continued.
authors.affiliation: WHO Collaborating Centre for Non Communicable Diseases Prevention and Control and IDF Centre of Education, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India, drmohans@diabetes.ind.in.
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Mohan
authors.forename: Manni Mohanraj
authors.initials: MM
authors.lastname: Mahalakshmi
authors.forename: Balaji
authors.initials: B
authors.lastname: Bhavadharini
authors.forename: Kumar
authors.initials: K
authors.lastname: Maheswari
authors.forename: Gunasekaran
authors.initials: G
authors.lastname: Kalaiyarasi
authors.forename: Ranjit Mohan
authors.initials: RM
authors.lastname: Anjana
authors.forename: Ram
authors.initials: R
authors.lastname: Uma
authors.forename: Sriram
authors.initials: S
authors.lastname: Usha
authors.forename: Mohan
authors.initials: M
authors.lastname: Deepa
authors.forename: Ranjit
authors.initials: R
authors.lastname: Unnikrishnan
authors.forename: Sonak D
authors.initials: SD
authors.lastname: Pastakia
authors.forename: Belma
authors.initials: B
authors.lastname: Malanda
authors.forename: Anne
authors.initials: A
authors.lastname: Belton
authors.forename: Arivudainambi
authors.initials: A
authors.lastname: Kayal
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis*; D005215:Fasting / Q000097:blood*; D005260:Female; D005951:Glucose Tolerance Test / Q000379:methods; D006801:Humans; D008403:Mass Screening / Q000379:methods; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult