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1.
J Nutr ; 151(9): 2513-2521, 2021 09 04.
Article in English | MEDLINE | ID: covidwho-1758779

ABSTRACT

BACKGROUND: Although intake of Hass avocado has been cross-sectionally linked to lower abdominal obesity, knowledge of the effects of avocado consumption on abdominal adiposity and glycemic outcomes remains limited. OBJECTIVE: The effects of avocado consumption on abdominal adiposity, insulin resistance, oral-glucose-tolerance test (OGTT), and estimated ß-cell function were evaluated. METHODS: A total of 105 adults aged 25-45 y (61% female) with BMI ≥25 kg/m2 were randomly assigned to an intervention (N = 53) that received a daily meal with 1 fresh Hass avocado or a control (N = 52) that received an isocaloric meal with similar ingredients without avocado for 12 wk. DXA was used to assess the primary outcomes of abdominal adiposity [visceral adipose tissue (VAT), subcutaneous abdominal adipose tissue (SAAT), and the ratio of VAT to SAAT (VS Ratio)]. Fasted glucose and insulin were used to assess the primary outcomes of insulin resistance (HOMA-IR), and insulin sensitivity (Matsuda index) and ß-cell function (Insulinogenic index) were estimated using an OGTT. Changes between groups were compared using an ANCOVA. Secondary analyses were conducted based on sex. RESULTS: The control group exhibited a greater reduction in SAAT [-54.5 ± 155.8 g (control) compared with 17.4 ± 155.1 g (treatment), P = 0.017] and increase in VS Ratio [0.007 ± 0.047 (control) compared with -0.011 ± 0.044 (treatment), P = 0.024]. Among females, the treatment group exhibited a greater reduction in VAT [1.6 ± 89.8 g (control) compared with -32.9 ± 81.6 g (treatment), P = 0.021] and VS Ratio [0.01 ± 0.05 (control) compared with -0.01 ± 0.03 (treatment), P = 0.001]. Among males, there was no significant difference between groups in changes in abdominal adiposity or glycemic outcomes. CONCLUSIONS: Daily consumption of 1 fresh Hass avocado changed abdominal adiposity distribution among females but did not facilitate improvements in peripheral insulin sensitivity or ß-cell function among adults with overweight and obesity.This study was registered at clinicaltrials.gov as NCT02740439.


Subject(s)
Insulin Resistance , Persea , Adiposity , Body Mass Index , Female , Glucose Tolerance Test , Humans , Intra-Abdominal Fat , Male , Obesity , Obesity, Abdominal , Overweight
2.
JAMA Netw Open ; 5(3): e220773, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1718200

ABSTRACT

Importance: Women with recent gestational diabetes (GDM) have increased risk of developing type 2 diabetes. Objective: To investigate whether a resource-appropriate and context-appropriate lifestyle intervention could prevent glycemic deterioration among women with recent GDM in South Asia. Design, Setting, and Participants: This randomized, participant-unblinded controlled trial investigated a 12-month lifestyle intervention vs usual care at 19 urban hospitals in India, Sri Lanka, and Bangladesh. Participants included women with recent diagnosis of GDM who did not have type 2 diabetes at an oral glucose tolerance test (OGTT) 3 to 18 months postpartum. They were enrolled from November 2017 to January 2020, and follow-up ended in January 2021. Data were analyzed from April to July 2021. Interventions: A 12-month lifestyle intervention focused on diet and physical activity involving group and individual sessions, as well as remote engagement, adapted to local context and resources. This was compared with usual care. Main Outcomes and Measures: The primary outcome was worsening category of glycemia based on OGTT using American Diabetes Association criteria: (1) normal glucose tolerance to prediabetes (ie, impaired fasting glucose or impaired glucose tolerance) or type 2 diabetes or (2) prediabetes to type 2 diabetes. The primary analysis consisted of a survival analysis of time to change in glycemic status at or prior to the final patient visit, which occurred at varying times after 12 months for each patient. Secondary outcomes included new-onset type 2 diabetes and change in body weight. Results: A total of 1823 women (baseline mean [SD] age, 30.9 [4.9] years and mean [SD] body mass index, 26.6 [4.6]) underwent OGTT at a median (IQR) 6.5 (4.8-8.2) months postpartum. After excluding 160 women (8.8%) with type 2 diabetes, 2 women (0.1%) who met other exclusion criteria, and 49 women (2.7%) who did not consent or were uncontactable, 1612 women were randomized. Subsequently, 11 randomized participants were identified as ineligible and excluded from the primary analysis, leaving 1601 women randomized (800 women randomized to the intervention group and 801 women randomized to usual care). These included 600 women (37.5%) with prediabetes and 1001 women (62.5%) with normoglycemia. Among participants randomized to the intervention, 644 women (80.5%) received all program content, although COVID-19 lockdowns impacted the delivery model (ie, among 644 participants who engaged in all group sessions, 476 women [73.9%] received some or all content through individual engagement, and 315 women [48.9%] received some or all content remotely). After a median (IQR) 14.1 (11.4-20.1) months of follow-up, 1308 participants (81.2%) had primary outcome data. The intervention, compared with usual care, did not reduce worsening glycemic status (204 women [25.5%] vs 217 women [27.1%]; hazard ratio, 0.92; [95% CI, 0.76-1.12]; P = .42) or improve any secondary outcome. Conclusions and Relevance: This study found that a large proportion of women in South Asian urban settings developed dysglycemia soon after a GDM-affected pregnancy and that a lifestyle intervention, modified owing to the COVID-19 pandemic, did not prevent subsequent glycemic deterioration. These findings suggest that alternate or additional approaches are needed, especially among high-risk individuals. Trial Registration: Clinical Trials Registry of India Identifier: CTRI/2017/06/008744; Sri Lanka Clinical Trials Registry Identifier: SLCTR/2017/001; and ClinicalTrials.gov Identifier: NCT03305939.


Subject(s)
Diabetes Mellitus, Type 2/prevention & control , Diabetes, Gestational/prevention & control , Diet , Exercise , Glycemic Control/methods , Life Style , Postpartum Period , Adult , Bangladesh , Blood Glucose , Diabetes Mellitus, Type 2/ethnology , Diabetes, Gestational/ethnology , Female , Glucose Tolerance Test , Humans , India , Pregnancy , Sri Lanka , Survival Analysis , Treatment Outcome , Urban Population
3.
Int J Environ Res Public Health ; 19(3)2022 Feb 08.
Article in English | MEDLINE | ID: covidwho-1674643

ABSTRACT

BACKGROUND: Due to COVID-19, many centres adopted a change to the diagnosis of GDM. METHODS: A case-control study of antenatal patients between 1 April and 30 June in 2019 and 2020 looking at detection rates of GDM, use of medication, obstetric, and fetal outcomes. RESULTS: During COVID-19, the rate of positive GDM tests approximately halved (20% (42/210) in 2020 vs. 42.2% (92/218) in 2019, (p < 0.01)) with higher rates of requirement for insulin at diagnosis (21.4% (2020) vs. 2.2% (2019); p < 0.01), and at term (31% (2020) vs. 5.4% (2019); p < 0.01). and metformin at diagnosis (4.8% (2020) vs. 1.1% (2019); p < 0.01), and at term (14.3% (2020) vs. 7.6% (2019) p < 0.01), with no differences in birth outcomes. CONCLUSIONS: There was likely an underdiagnosis of GDM while women at a higher risk of hyperglycaemia were correctly identified. The GTT should be maintained as the gold-standard test where possible, with provisions made for social distancing during testing if required.


Subject(s)
COVID-19 , Diabetes, Gestational , Case-Control Studies , Diabetes, Gestational/diagnosis , Diabetes, Gestational/epidemiology , Female , Glucose Tolerance Test , Humans , Pandemics , Pregnancy , Pregnancy Outcome/epidemiology , SARS-CoV-2
4.
BMJ Open Diabetes Res Care ; 9(2)2021 12.
Article in English | MEDLINE | ID: covidwho-1598547

ABSTRACT

INTRODUCTION: Early diagnosis of prediabetes based on blood sampling for the oral glucose tolerance test (OGTT) is crucial for intervention but multiple barriers hinder its uptake. This study aimed to assess the feasibility and precision of a self-administered capillary OGTT for type-2 diabetes mellitus (T2DM) in high-risk individuals. RESEARCH DESIGN AND METHODS: Participants with history of gestational diabetes or prediabetes were recruited in primary care. Due to their prediabetic status and previous diagnosis of gestational diabetes mellitus, a proportion of participants had previous experience doing OGTT. They self-administered the capillary OGTT and concurrently their venous glucose samples were obtained. They filled a questionnaire to collect their demographic information, views of their capillary OGTT, and their preferred site of the test. RESULTS: Among 30 participants enrolled in this feasibility study, 93.3% of them felt confident of performing the capillary OGTT themselves, and 70.0% preferred the test at home. Older, less educated participants found it less acceptable. Mean capillary glucose values were significantly higher than venous glucose values, with mean difference at 0.31 mmol/L (95% CI 0.13 to 0.49) at fasting, and 0.47 mmol/L (95% CI 0.12 to 0.92) 2 hours post-OGTT. Capillary and venous glucose measurements were correlated for fasting (r=0.95; p<0.001) and 2-hour-post-OGTT (r=0.95;p<0.001). The Fleiss-Kappa Score (0.79, p<0.0001) indicated fair agreement between the two methods. The capillary OGTT had excellent sensitivity (94.1%) and negative predictive value (NPV=91.7%) in identifying prediabetes or T2DM status, vis-a-vis to venous glucose samples. CONCLUSION: Self-administered capillary OGTT is feasible and acceptable, especially among younger adults, with excellent sensitivity and NPV compared with plasma-based OGTT.


Subject(s)
Diabetes, Gestational , Prediabetic State , Adult , Blood Glucose , Diabetes, Gestational/diagnosis , Feasibility Studies , Female , Glucose Tolerance Test , Humans , Prediabetic State/diagnosis , Pregnancy
5.
Cells ; 10(12)2021 12 08.
Article in English | MEDLINE | ID: covidwho-1597185

ABSTRACT

Beta-3 adrenergic receptor activation via exercise or CL316,243 (CL) induces white adipose tissue (WAT) browning, improves glucose tolerance, and reduces visceral adiposity. Our aim was to determine if sex or adipose tissue depot differences exist in response to CL. Daily CL injections were administered to diet-induced obese male and female mice for two weeks, creating four groups: male control, male CL, female control, and female CL. These groups were compared to determine the main and interaction effects of sex (S), CL treatment (T), and WAT depot (D). Glucose tolerance, body composition, and energy intake and expenditure were assessed, along with perigonadal (PGAT) and subcutaneous (SQAT) WAT gene and protein expression. CL consistently improved glucose tolerance and body composition. Female PGAT had greater protein expression of the mitochondrial uncoupling protein 1 (UCP1), while SQAT (S, p < 0.001) was more responsive to CL in increasing UCP1 (S×T, p = 0.011) and the mitochondrial biogenesis induction protein, PPARγ coactivator 1α (PGC1α) (S×T, p = 0.026). Females also displayed greater mitochondrial OXPHOS (S, p < 0.05) and adiponectin protein content (S, p < 0.05). On the other hand, male SQAT was more responsive to CL in increasing protein levels of PGC1α (S×T, p = 0.046) and adiponectin (S, p < 0.05). In both depots and in both sexes, CL significantly increased estrogen receptor beta (ERß) and glucose-related protein 75 (GRP75) protein content (T, p < 0.05). Thus, CL improves systemic and adipose tissue-specific metabolism in both sexes; however, sex differences exist in the WAT-specific effects of CL. Furthermore, across sexes and depots, CL affects estrogen signaling by upregulating ERß.


Subject(s)
Adipose Tissue, Brown/metabolism , HSP70 Heat-Shock Proteins/genetics , Membrane Proteins/genetics , PPAR gamma/genetics , Peroxisome Proliferator-Activated Receptor Gamma Coactivator 1-alpha/genetics , Uncoupling Protein 1/genetics , Adipose Tissue/metabolism , Adipose Tissue, Brown/growth & development , Adipose Tissue, White/metabolism , Animals , Body Composition/genetics , Dioxoles/pharmacology , Energy Metabolism/genetics , Estrogen Receptor beta/genetics , Estrogens/genetics , Estrogens/metabolism , Female , Glucose Tolerance Test , Humans , Male , Mice , Mitochondria/genetics , Mitochondria/metabolism , Receptors, Adrenergic, beta-3/genetics , Receptors, Adrenergic, beta-3/metabolism , Sex Characteristics
6.
Diabetes Res Clin Pract ; 183: 109149, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1520814

ABSTRACT

AIM: Although an increased risk of gestational diabetes mellitus (GDM) has been noted in women exposed to stressful conditions and traumatic events, limited information is available about such risk in the context of the COVID-19 pandemic. METHODS: The study was designed as a non-concurrent case-control study on the prevalence of GDM, defined according to IADPSG 2010, in women giving birth during the COVID-19 pandemic in the hot spot of Northeast Italy from March 9th to May 18th, 2020, with an antecedent puerperae-matched group whose women had given birth in 2019. RESULTS: Analysis revealed that during the COVID-19 pandemic in 2020, GDM prevalence was significantly higher than in 2019 (GDM, 48/533, 9 vs 86/637, 13.5%, p = 0.01), as illustrated by a higher GDM prevalence in 5/6 months of the final semester of 2020. In addition, logistic regression analysisconfirmed a statistically significant temporal relationship between experiencing the lockdown during the first trimester of gestation and later GDM incidence (t = 2.765, P = 0.012), with an 34% increase in mean number of GDM diagnoses per month (antilog of the parameter = 1.34). CONCLUSION: The COVID-19 pandemic negatively impacted GDM prevalence in 2020 compared to 2019, especially for pregnant women in the 1st trimester of gestation.


Subject(s)
COVID-19 , Diabetes, Gestational , Case-Control Studies , Communicable Disease Control , Diabetes, Gestational/epidemiology , Female , Glucose Tolerance Test , Humans , Pandemics , Pregnancy , Prevalence , Risk Factors , SARS-CoV-2
7.
BJOG ; 128(11): 1881-1887, 2021 10.
Article in English | MEDLINE | ID: covidwho-1429452

ABSTRACT

OBJECTIVE: To test the hypothesis that there is seasonal variation in the rates of gestational diabetes (GDM) diagnosed using a 2-hour oral glucose tolerance test. DESIGN: Monthly assessment of the percentage of women screened from 1 April 2016 to the 31 December 2020 who were diagnosed as having gestational diabetes. SETTING: London teaching hospital. POPULATION: 28 128 women receiving antenatal care between 1 April 2016 and 31 December 2020. METHODS: Retrospective study of prospectively collected data. MAIN OUTCOME MEASURES: Proportion of women screened diagnosed as having gestational diabetes. RESULTS: The mean (SD) percentage of women diagnosed with GDM was 14.78 (2.24) in summer (June, July, August) compared with 11.23 (1.62) in winter (P < 0.001), 12.13 (1.94) in spring (P = 0.002) and 11.88 (2.67) in autumn (P = 0.003). There was a highly significant positive correlation of the percentage testing positive for GDM with the mean maximum monthly temperature (R2  = 0.248, P < 0.001). There was a statistically significant 33.8% increase in the proportion of GDM diagnoses from June 2020 onwards, possibly related to a reduction in exercise secondary to the Covid-19 pandemic. CONCLUSIONS: There is a 23.3% higher rate of GDM diagnoses in the warmer summer months. There has been a 33.8% rise in GDM diagnoses associated with the Covid-19 pandemic. TWEETABLE ABSTRACT: Rates of GDM are higher in summer and since the onset of the Covid-19 pandemic.


Subject(s)
COVID-19 , Diabetes, Gestational/epidemiology , Seasons , Adult , Female , Glucose Tolerance Test , Humans , Incidence , London/epidemiology , Pregnancy , Prospective Studies , Retrospective Studies , SARS-CoV-2
9.
BJOG ; 128(11): 1881-1887, 2021 10.
Article in English | MEDLINE | ID: covidwho-1247108

ABSTRACT

OBJECTIVE: To test the hypothesis that there is seasonal variation in the rates of gestational diabetes (GDM) diagnosed using a 2-hour oral glucose tolerance test. DESIGN: Monthly assessment of the percentage of women screened from 1 April 2016 to the 31 December 2020 who were diagnosed as having gestational diabetes. SETTING: London teaching hospital. POPULATION: 28 128 women receiving antenatal care between 1 April 2016 and 31 December 2020. METHODS: Retrospective study of prospectively collected data. MAIN OUTCOME MEASURES: Proportion of women screened diagnosed as having gestational diabetes. RESULTS: The mean (SD) percentage of women diagnosed with GDM was 14.78 (2.24) in summer (June, July, August) compared with 11.23 (1.62) in winter (P < 0.001), 12.13 (1.94) in spring (P = 0.002) and 11.88 (2.67) in autumn (P = 0.003). There was a highly significant positive correlation of the percentage testing positive for GDM with the mean maximum monthly temperature (R2  = 0.248, P < 0.001). There was a statistically significant 33.8% increase in the proportion of GDM diagnoses from June 2020 onwards, possibly related to a reduction in exercise secondary to the Covid-19 pandemic. CONCLUSIONS: There is a 23.3% higher rate of GDM diagnoses in the warmer summer months. There has been a 33.8% rise in GDM diagnoses associated with the Covid-19 pandemic. TWEETABLE ABSTRACT: Rates of GDM are higher in summer and since the onset of the Covid-19 pandemic.


Subject(s)
COVID-19 , Diabetes, Gestational/epidemiology , Seasons , Adult , Female , Glucose Tolerance Test , Humans , Incidence , London/epidemiology , Pregnancy , Prospective Studies , Retrospective Studies , SARS-CoV-2
11.
Nutr Metab Cardiovasc Dis ; 30(9): 1418-1422, 2020 08 28.
Article in English | MEDLINE | ID: covidwho-1121395

ABSTRACT

AIM: In response to the COVID-19 pandemic, there is a need for substantial changes in the procedures for accessing healthcare services. Even in the current pandemic, we should not reduce our attention towards the diagnosis and treatment of GDM. The purpose of this document is to provide a temporary guide for GDM screening, replacing the current guidelines when it is not possible to implement standard GDM screening because of an unfavorable risk/benefit ratio for pregnant women or when usual laboratory facilities are not available. DATA SYNTHESIS: At the first visit during pregnancy, we must exclude the presence of "Overt diabetes" in all women. The criteria for the diagnosis of overt diabetes are either fasting plasma glucose ≥126 mg/dL, or random plasma glucose ≥200 mg/dL, or glycated hemoglobin ≥6.5%. When the screening procedure (OGTT) cannot be safely performed, the diagnosis of GDM is acceptable if fasting plasma glucose is ≥ 92 mg/dL. In order to consider the impaired fasting glucose as an acceptable surrogate for the diagnosis of GDM, the fasting glucose measurement should be performed within the recommended time windows for the risk level (high or medium risk). CONCLUSIONS: The changes to the screening procedure for GDM reported below are specifically produced in response to the health emergency of the COVID-19 pandemic. Therefore, these recommended changes should cease to be in effect and should be replaced by current national guidelines when the healthcare authorities declare the end of this emergency.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Diabetes, Gestational/diagnosis , Pneumonia, Viral/epidemiology , Blood Glucose/analysis , COVID-19 , Female , Glucose Tolerance Test , Humans , Italy , Pandemics , Pregnancy , SARS-CoV-2
12.
PLoS One ; 15(12): e0243192, 2020.
Article in English | MEDLINE | ID: covidwho-1004444

ABSTRACT

OBJECTIVE: To evaluate the role of fasting blood glucose (FBG) to minimise the use of the oral glucose tolerance test in pregnancy (POGTT) for the diagnosis of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: We analysed the POGTTs of 26,242 pregnant women in Queensland, Australia, performed between 1 January 2015 and 30 June 2015. A receiver operator characteristics (ROC) assessment was undertaken to indicate the FBG level that most effectively identified women at low risk of an abnormal result. RESULTS: There were 3,946 (15.0%) patients having GDM with 2,262 (8.6%) having FBG ≥ 5.1mmol/l. The ROC identified FBG levels >4.6mmol/l having the best specificity (77%) and sensitivity (54%) for elevated 1 and/or 2hr BGLs. There were 19,321 (73.7%) women having FBG < 4.7mmol/l with a prevalence of GDM of 4.0%, less than 1/3rd the overall rate. Only 4,638 (17.7%) women having FBGs from 4.7-5.0mmol/l would require further evaluation to confirm or exclude the diagnosis. CONCLUSION: This contemporary study of women across the state of Queensland, Australia suggests the FBG can be used effectively to define glucose tolerance in pregnancy, minimising their contact with pathology laboratories and potential exposure to the corona virus. This analysis, used in conjunction with outcome data from the HAPO study, provides reassurance to women and their health professionals that FBG < 4.7mmol/l has both a low rate of abnormal glucose tolerance and minimal adverse pregnancy-associated complications.


Subject(s)
Blood Glucose/analysis , COVID-19/epidemiology , Diabetes, Gestational/blood , Adult , Blood Glucose/metabolism , Diabetes, Gestational/diagnosis , Diabetes, Gestational/epidemiology , Fasting/metabolism , Female , Glucose Tolerance Test/methods , Glucose Tolerance Test/standards , Humans , Pregnancy , Queensland
13.
Diabetes Res Clin Pract ; 172: 108640, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-996825

ABSTRACT

AIMS: To evaluate proposals considering HbA1c and fasting plasma glucose (FPG) measurement as a substitute for oral glucose tolerance test (OGTT) to diagnose hyperglycaemia in pregnancy (HIP) during COVID-19 pandemic. METHODS: Of the 7,334 women who underwent the OGTT between 22 and 30 weeks gestation, 966 had HIP (WHO diagnostic criteria, reference standard). The 467 women who had an available HbA1c were used for analysis. French-speaking Society of Diabetes (SFD) proposal to diagnose HIP during COVID-19 pandemic was retrospectively applied: HbA1c ≥5.7% (39 mmol/mol) and/or FPG level ≥5.1 mmol/l. SFD proposal sensitivity for HIP diagnosis and the occurrence of HIP-related events (preeclampsia, large for gestational age infant, shoulder dystocia or neonatal hypoglycaemia) in women with false negative (FN) and true positive (TP) HIP-diagnoses were evaluated. RESULTS: The sensitivity was 57% [95% confidence interval 52-62]. FN women had globally lower plasma glucose levels during OGTT, lower HbA1c and body mass index than those TP. The percentage of HIP-related events was similar in FN (who were cared) and TP cases, respectively 19.5 and 16.9% (p = 0.48). We observed similar results when women at high risk for HIP only were considered. CONCLUSION: The SFD proposal has a poor sensitivity to detect HIP. Furthermore, it fails to have any advantages in predicting adverse outcomes.


Subject(s)
Blood Glucose/metabolism , COVID-19/epidemiology , Fasting/blood , Glycated Hemoglobin A/metabolism , Hyperglycemia/blood , Pregnancy Complications , SARS-CoV-2 , Adult , Comorbidity , Female , Glucose Tolerance Test , Humans , Hyperglycemia/epidemiology , Infant, Newborn , Pandemics , Pregnancy , Prognosis , Retrospective Studies , Risk Factors
14.
J Clin Endocrinol Metab ; 106(2): e836-e854, 2021 01 23.
Article in English | MEDLINE | ID: covidwho-922691

ABSTRACT

AIMS: To determine impact of mild fasting hyperglycemia in early pregnancy (fasting plasma glucose [FPG] 5.1-5.5 mmol/L) on pregnancy outcomes. METHODS: We measured FPG at 11.9 ± 1.8 weeks in 2006 women from a prospective cohort study. Women with FPG ≥5.6 mmol/L (19) received treatment and were excluded from further analyses. A total of 1838 women with FPG <5.6 mmol/L received a 75 g oral glucose tolerance test (OGTT) between 24 and 28 weeks of pregnancy. RESULTS: Of all participants, 78 (4.2%) had FPG 5.1 to 5.5 mmol/L in early pregnancy, of which 49 had a normal OGTT later in pregnancy (high fasting normal glucose tolerance [NGT] group). Compared with the NGT group with FPG <5.1 mmol/L in early pregnancy (low fasting NGT group, n = 1560), the high fasting NGT group had a higher body mass index (BMI), higher insulin resistance with more impaired insulin secretion and higher FPG and 30 minute glucose levels on the OGTT. The admission rate to neonatal intensive care unit (NICU) was significantly higher in the high fasting NGT group than in the low fasting NGT group (20.4% [10] vs 9.3% [143], P = .009), with no difference in duration (7.0 ± 8.6 vs 8.4 ± 14.3 days, P = .849) or indication for NICU admission between both groups. The admission rate to NICU remained significantly higher (odds ratio 2.47; 95% confidence interval 1.18-5.19, P = .017) after adjustment for age, BMI, and glucose levels at the OGTT. CONCLUSIONS: When provision of an OGTT is limited such as in the Covid-19 pandemic, using FPG in early pregnancy could be an easy alternative to determine who is at increased risk for adverse pregnancy outcomes.


Subject(s)
Fasting/blood , Hyperglycemia/blood , Intensive Care, Neonatal/statistics & numerical data , Patient Admission/statistics & numerical data , Pregnancy Complications/blood , Adult , Blood Glucose/analysis , COVID-19 , Female , Gestational Age , Glucose Tolerance Test , Humans , Hyperglycemia/diagnosis , Hyperglycemia/epidemiology , Infant, Newborn , Infant, Newborn, Diseases/epidemiology , Infant, Newborn, Diseases/etiology , Infant, Newborn, Diseases/therapy , Pandemics , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/epidemiology , Pregnancy Outcome/epidemiology , Prenatal Exposure Delayed Effects/blood , Prenatal Exposure Delayed Effects/epidemiology , Prenatal Exposure Delayed Effects/therapy , Prospective Studies , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Young Adult
16.
Aust N Z J Obstet Gynaecol ; 60(5): 671-674, 2020 10.
Article in English | MEDLINE | ID: covidwho-652304

ABSTRACT

BACKGROUND: Multiple professional bodies have temporarily revised recommendations for gestational diabetes mellitus (GDM) testing during the COVID-19 pandemic to reduce person-to-person contact. The current Australian temporary criteria advise that if the fasting glucose is ≤4.6 mmol/L, then no glucose tolerance test (GTT) is required. AIMS: The aim of this study is to examine the extent of underdiagnosis of GDM using a fasting glucose ≤4.6 mmol/L as a cut-off to determine that a GTT is not necessary. MATERIALS AND METHODS: De-identified data from pregnant women having a GTT test in the Illawarra area during a six-year period was used to determine the number of women with GDM and the proportion of positive cases that would be missed for different fasting glucose values. RESULTS: There were 16 522 results identified and GDM was diagnosed in 12.2%. The majority of women were more than 30 years of age (85.2%) and diagnosed at ≥20 weeks gestation (81.1%). Of those diagnosed with GDM, 29% had a fasting glucose of ≤4.6 mmol/L and would have been missed. CONCLUSIONS: Our results show that using a fasting glucose of 4.6 mmol/L or less would miss nearly a third of women who would otherwise be diagnosed with GDM.


Subject(s)
Coronavirus Infections/prevention & control , Diabetes, Gestational/diagnosis , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pregnancy Complications, Infectious/prevention & control , Pregnancy Outcome , Severe Acute Respiratory Syndrome/prevention & control , Adult , Australia , Blood Glucose/analysis , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Cohort Studies , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Databases, Factual , Female , Glucose Tolerance Test , Humans , Infection Control/methods , Patient Isolation/methods , Pneumonia, Viral/epidemiology , Pregnancy , Prenatal Care/methods , Retrospective Studies , Risk Assessment , Severe Acute Respiratory Syndrome/epidemiology
18.
Aust N Z J Obstet Gynaecol ; 60(5): 660-666, 2020 10.
Article in English | MEDLINE | ID: covidwho-703592

ABSTRACT

The balance between avoiding severe acute respiratory syndrome coronavirus-2 contagion and reducing wider clinical risk is unclear for gestational diabetes mellitus (GDM) testing. Recent recommendations promote diagnostic approaches that limit collection but increase undiagnosed GDM, which potentially increases adverse pregnancy outcome risks. The most sensitive approach to detecting GDM at 24-28 weeks beyond the two-hour oral glucose tolerance test (OGTT) is a one-hour OGTT (88% sensitivity). Less sensitive approaches use fasting glucose alone (≥5.1 mmol/L: misses 44-54% GDM) or asking ~20% of women for a second visit (fasting glucose 4.7-5.0 mmol/L (62-72% sensitive)). Choices should emphasise local and patient decision-making.


Subject(s)
Coronavirus Infections/prevention & control , Diabetes, Gestational/diagnosis , Pandemics/prevention & control , Patient Isolation/methods , Pneumonia, Viral/prevention & control , Pregnancy Complications, Infectious/prevention & control , Prenatal Diagnosis/methods , Adult , Blood Glucose/analysis , COVID-19 , Clinical Decision-Making , Coronavirus Infections/epidemiology , Female , Gestational Age , Glucose Tolerance Test/methods , Humans , Infection Control/methods , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Pregnancy , Pregnancy Outcome , Risk Assessment
19.
Diabet Med ; 38(1): e14380, 2021 01.
Article in English | MEDLINE | ID: covidwho-693232

ABSTRACT

AIM: To evaluate the diagnostic and prognostic performance of alternative diagnostic strategies to oral glucose tolerance tests, including random plasma glucose, fasting plasma glucose and HbA1c , during the COVID-19 pandemic. METHODS: Retrospective service data (Cambridge, UK; 17 736 consecutive singleton pregnancies, 2004-2008; 826 consecutive gestational diabetes pregnancies, 2014-2019) and 361 women with ≥1 gestational diabetes risk factor (OPHELIA prospective observational study, UK) were included. Pregnancy outcomes included gestational diabetes (National Institute of Health and Clinical Excellence or International Association of Diabetes and Pregnancy Study Groups criteria), diabetes in pregnancy (WHO criteria), Caesarean section, large-for-gestational age infant, neonatal hypoglycaemia and neonatal intensive care unit admission. Receiver-operating characteristic curves and unadjusted logistic regression were used to compare random plasma glucose, fasting plasma glucose and HbA1c performance. RESULTS: Gestational diabetes diagnosis was significantly associated with random plasma glucose at 12 weeks [area under the receiver-operating characteristic curve for both criteria 0.81 (95% CI 0.79-0.83)], fasting plasma glucose [National Institute of Health and Clinical Excellence: area under the receiver-operating characteristic curve 0.75 (95% CI 0.65-0.85); International Association of Diabetes and Pregnancy Study Groups: area under the receiver-operating characteristic curve 0.92 (95% CI 0.85-0.98)] and HbA1c at 28 weeks' gestation [National Institute of Health and Clinical Excellence: 0.83 (95% CI 0.75-0.90); International Association of Diabetes and Pregnancy Study Groups: 0.84 (95% CI 0.77-0.91)]. Each measure predicts some, but not all, pregnancy outcomes studied. At 12 weeks, ~5% of women would be identified using random plasma glucose ≥8.5 mmol/l (sensitivity 42%; specificity 96%) and at 28 weeks using HbA1c ≥39 mmol/mol (sensitivity 26%; specificity 96%) or fasting plasma glucose ≥5.2-5.4 mmol/l (sensitivity 18-41%; specificity 97-98%). CONCLUSIONS: Random plasma glucose at 12 weeks, and fasting plasma glucose or HbA1c at 28 weeks identify women with hyperglycaemia at risk of suboptimal pregnancy outcomes. These opportunistic laboratory tests perform adequately for risk stratification when oral glucose tolerance testing is not available.


Subject(s)
COVID-19/prevention & control , Diabetes, Gestational/diagnosis , Hyperglycemia/diagnosis , Mass Screening/methods , SARS-CoV-2 , Adult , Blood Glucose/analysis , COVID-19/epidemiology , Comorbidity , Diabetes, Gestational/epidemiology , Fasting/blood , Female , Gestational Age , Glucose Tolerance Test , Glycated Hemoglobin A/analysis , Humans , Pandemics , Pregnancy , Pregnancy Outcome/epidemiology , Retrospective Studies , Risk Factors , Sensitivity and Specificity , United Kingdom/epidemiology
20.
Diabetes Res Clin Pract ; 167: 108353, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-688787

ABSTRACT

AIMS: We assessed how altered diagnostic processes and criteria for gestational diabetes mellitus (GDM) recommended by the United Kingdom (UK), Canada and Australia for use during the COVID-19 pandemic would affect both GDM frequency and related adverse outcomes. METHODS: Secondary analysis of 5974 HAPO study women with singleton pregnancies who underwent 75 g OGTTs and HbA1c assays between 24 and 32 weeks' gestation and who received no treatment for GDM. RESULTS: All post COVID-19 modified pathways reduced GDM frequency - UK (81%), Canada (82%) and Australia (25%). Canadian women whose GDM would remain undetected post COVID-19 (missed GDMs) displayed similar rates of pregnancy complications to those with post COVID-19 GDM. Using UK modifications, the missed GDM group were at slightly lower risk whilst the women missed using the Australian modifications were at substantially lower risk. CONCLUSIONS: The modifications in GDM diagnosis proposed for the UK, Canada and Australia result in differing reductions of GDM frequency. Each has both potential benefits in terms of reduction in potential exposure to COVID-19 and costs in terms of missed opportunities to influence pregnancy and postpartum outcomes. These factors should be considered when deciding which protocol is most appropriate for a particular context.


Subject(s)
Blood Glucose/metabolism , Coronavirus Infections/prevention & control , Diabetes, Gestational/diagnosis , Glucose Tolerance Test/methods , Missed Diagnosis/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pregnancy Complications, Infectious/prevention & control , Adult , Australia , Betacoronavirus , COVID-19 , Canada , Diabetes, Gestational/metabolism , Fasting , Female , Glycated Hemoglobin A/metabolism , Humans , Practice Guidelines as Topic , Pregnancy , Pregnancy Outcome , Pregnancy Trimester, Second , Pregnancy Trimester, Third , SARS-CoV-2 , United Kingdom
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