title: Candy twists as an alternative to the glucola beverage in gestational diabetes mellitus screening.
abstract: OBJECTIVE
  Screening for gestational diabetes mellitus commonly uses an oral glucose challenge test with a 50-g glucola beverage and subsequent venous puncture. However, up to 30% of pregnant women report significant side-effects, and the beverage is costly. We hypothesized that equivalent glucose loads could be achieved from a popular candy twist (Twizzlers; The Hershey Company, Hershey, PA) and tested it as cost-effective, tolerable alternative with a test of equivalency.
  
  
  METHODS
  The glucose equivalent of the 50-g glucola was calculated as 10 candy twists. We initially used a triple crossover design in nonpregnant patients whereby each subject served as her own control; this ensured the safety and equivalency of this load before using it among pregnant subjects. We then recruited pregnant women with an abnormal screening at 1 hour (glucose challenge test) in a double crossover design study. Subjects consumed 10 candy twists with a 1-hour venous blood glucose assessment. All subjects subsequently completed the confirmatory 3-hour glucose tolerance test. Sensitivity, specificity, positive predictive values, negative predictive values, false-referral rates, and detection rates were calculated.
  
  
  RESULTS
  At ≥130 mg/dL, the sensitivity (100%) was the same for candy twists and glucola. However, the false-referral rate (82% vs 90%), positive predictive value (18% vs 10%), and detection rate (18% vs 10%) were improved for candy twists when compared with the 50-g glucola beverage.
  
  
  CONCLUSIONS
  Our results indicate that strawberry-flavored candy twists are potentially an equally effective screening test, compared with the gold standard glucola beverage but lead to fewer false-positive screens and therefore could be a cost-effective alternative.
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
authors.forename: Diana A
authors.initials: DA
authors.lastname: Racusin
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Antony
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
authors.forename: Lori
authors.initials: L
authors.lastname: Showalter
authors.affiliation: Divisions of Endocrinology and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
authors.forename: Susan
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Divisions of Endocrinology and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
authors.forename: Morey
authors.initials: M
authors.lastname: Haymond
authors.affiliation: Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX; Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX. Electronic address: aagaardt@bcm.tmc.edu.
authors.forename: Kjersti M
authors.initials: KM
authors.lastname: Aagaard
mesh_terms: D000328:Adult; D001628:Beverages; D002182:Candy; D002241:Carbohydrates; D018592:Cross-Over Studies; D016640:Diabetes, Gestational / Q000175:diagnosis*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D011247:Pregnancy; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
chemical_list: D002241:Carbohydrates; C007853:Glucola
keywords: diabetes mellitus; gestational diabetes mellitus; screening