Effect of Prolonged Fasting Duration on 50 Gram Oral Glucose Challenge Test in the Diagnosis of Gestational Diabetes Mellitus

Abstract

The aim of this study was to investigate the association between fasting duration before screening with 50 g glucose challenge test (GCT) and the test outcome. For this cross-sectional study, we enrolled 508 low-risk pregnant women who underwent 50 g GCT between the 24 and 28 weeks of gestation. We excluded women with pregestational diabetes, multiple gestations or a history of gestational diabetes mellitus (GDM), and macrosomia. We evaluated fasting durations, GCT results, and demographic features. A significant positive correlation was found between fasting duration and 50 g GCT values (r=0.122; p=0.006), and the best cut-off value was found to be 6.5 h, with 85.85% sensitivity and 38.61% specificity (relative risk, 2.73; 95% CI, 1.893–3.936; p<0.0001). Further, we divided the patients into two groups: study (fasting, <6.5 h; n=146) and control (fasting,>6.5 h; n=362) groups. Notably, the mean glucose levels, number of patients with GCT>140 mg/dl, and rates of unnecessary 100 g loadings were significantly higher in the study group. We found no significant differences between the groups in terms of the fasting plasma glucose levels and GDM prevalence. According to our findings, fasting duration of>6.5 h resulted in 2.7 times more unnecessary 100 g glucose tolerance tests (GTT). We recommend that patients having fasted for>6.5 h receive a one-step 75 g GTT after completing 8-h fasting.

Key words

glucose challenge test (GCT) - oral glucose challenge test (OGCT) - fasting duration - gestational diabetes mellitus

• References

• 1 Group HSCR. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. N Eng J Med 2008; 358: 1991-2002
• 2 Altay MM, Özdoğan S, Tohma A, Esin S, Erol O, Gelişen O, Akkuş M, Karadeniz S. Can the 3rd Hour Value of 100 g Oral Glucose Tolerance Test Be Ignored in the Diagnosis of Gestational Diabetes Mellitus?. Gynecol Obstet Reprod Med 2013; 19: 157-161
• 3 Kun A, Tornoczky J, Tabak AG. The prevalence and predictors of gestational diabetes mellitus in Hungary. Horm Metab Res 2011; 43: 788-793
• 4 Mayer KH, Stamler J, Dyer A, Freinkel N, Stamler R, Berkson DM, Farber B. Epidemiologic findings on the relationship of time of day and time since last meal to glucose tolerance. Diabetes 1976; 25: 936-943
• 5 Much D, Jaschinski H, Lack N, Hummel S, Fuchtenbusch M, Hummel M, Ziegler AG, Beyerlein A. Risk stratification in women with gestational diabetes according to and beyond current WHO criteria. Horm Metab Res 2016; 48: 16-19
• 6 Hassiakos D, Eleftheriades M, Papastefanou I, Lambrinoudaki I, Kappou D, Lavranos D, Akalestos A, Aravantinos L, Pervanidou P, Chrousos G. Increased maternal serum interleukin-6 concentrations at 11 to 14 weeks of gestation in low risk pregnancies complicated with gestational diabetes mellitus: Development of a prediction model. Horm Metab Res 2016; 48: 35-41
• 7 Goldberg RJ, Ye C, Sermer M, Connelly PW, Hanley AJ, Zinman B, Retnakaran R. Circadian variation in the response to the glucose challenge test in pregnancy: Implications for screening for gestational diabetes mellitus. Diabetes Care 2012; 35: 1578-1584
• 8 Campbell IT, Jarrett RJ, Keen H. Diurnal and seasonal variation in oral glucose tolerance: Studies in the Antarctic. Diabetologia 1975; 11: 139-145
• 9 Hulman A, Faerch K, Vistisen D, Karsai J, Nyari TA, Tabak AG, Brunner EJ, Kivimaki M, Witte DR. Effect of time of day and fasting duration on measures of glycaemia: Analysis from the Whitehall II Study. Diabetologia 2013; 56: 294-297
• 10 Committee on Practice B-O. ACOG practice bulletin no. 190: Gestational diabetes mellitus. Obstet Gynecol 2018; 131: e49-e64
• 11 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes care 2009; 32 (Suppl. 01) S62-S67
• 12 Wang P, Lu MC, Yu CW, Yan YH. Influence of the time of day and fasting duration on glucose level following a 1-hour, 50-gram glucose challenge test in pregnant women. PloS One 2014; 9: e112526
• 13 Moebus S, Gores L, Losch C, Jockel KH. Impact of time since last caloric intake on blood glucose levels. Eur J Epidemiol 2011; 26: 719-728
• 14 [Anonymous]. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA 2013; 310: 2191-2194
• 15 Sermer M, Naylor CD, Gare DJ, Kenshole AB, Ritchie JW, Farine D, Cohen HR, McArthur K, Holzapfel S, Biringer A, Chen E, Cadesky KI, Greenblatt EM, Leyland NA, Morris HS, Bloom JA, Abells YB. Toronto Tri-Hospital Gestational Diabetes Investigatiors. Impact of time since last meal on the gestational glucose challenge test. The Toronto Tri-Hospital Gestational Diabetes Project. Am J Obstet Gynecol 1994; 171: 607-616
• 16 International Association of D, Pregnancy Study Groups Consensus P. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva A, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676-682