Early Versus Routine Oral Glucose Tolerance Test in Women With Intermediate Hyperglycemia at First Prenatal Visit: A Retrospective Cohort Study in China

Background and ObjectivesIntermediate hyperglycemia in the first half of pregnancy, defined as a fasting plasma glucose level between 5.1- 6.9 mM, increases the risk of gestational diabetes mellitus, but clinical evidence for further management is lacking. We aim to evaluate the effectiveness of an early oral glucose tolerance test (OGTT) followed by the identification of intermediate hyperglycemia on pregnancy outcomes in real world setting.Subjects and MethodsA retrospective cohort study was conducted at the Obstetrics and Gynecology Hospital, Shanghai, China, between 2013 and 2017. Women with intermediate hyperglycemia at the first prenatal visit were identified and underwent an immediate (within one week) or a routine OGTT (24-28 gw) according to their wishes and received nutrition and exercise advice. Women diagnosed of gestational diabetes (GDM) were managed by standard interventions. Primary outcome was larger for gestational age (LGA). Secondary outcomes were primary cesarean delivery, preterm birth, shoulder dystocia or forceps delivery, preeclampsia, neonatal hypoglycemia, hyperbilirubinemia, and low Apgar score. Logistic regressions with or without a further propensity score-matched analysis were performed.ResultsAmong 42406 women involved, 1104 (2.6%) with intermediate hyperglycemia at the first prenatal visit were identified, of whom 176 (15.9%) underwent an early OGTT and 741 (67.1%) received a routine OGTT. Logistic regression showed that an early OGTT was not significantly associated with an altered risk of LGA (adjusted OR 1.13, 95% CI 0.73-1.75) but was related to an increased odds for neonatal hyperbilirubinemia (adjusted OR 2.89; 95% CI 1.55-5.37). No significant associations were observed for other secondary outcomes. These trends remained consistent in propensity score-matched models.ConclusionsOur data from a real-world setting did not support that an early OGTT among women with intermediate hyperglycemia at the first prenatal visit improved pregnancy outcomes.

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Comparison of Different Diagnostic Criteria for Gestational Diabetes Mellitus Based on the 75-G Oral Glucose Tolerance Test: A Cohort Study

Endocrine Practice ◽

10.4158/ep.ep.14.3.312 ◽

2008 ◽

Vol 14 (3) ◽

pp. 312-317

Author(s):

Nahid Shirazian ◽

Marjan Mahboubi ◽

Emdadi. Roya ◽

Reza Yousefi-Nooraie ◽

Zhaleh Fazel-Sarjuei ◽

...

Keyword(s):

Diabetes Mellitus ◽

Cohort Study ◽

Gestational Diabetes ◽

Glucose Tolerance ◽

Gestational Diabetes Mellitus ◽

Oral Glucose Tolerance Test ◽

Glucose Tolerance Test ◽

Tolerance Test ◽

Oral Glucose ◽

Oral Glucose Tolerance

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Abnormal fasting, post-load or combined glucose values on oral glucose tolerance test and pregnancy outcomes in women with gestational diabetes mellitus

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2020.108048 ◽

2020 ◽

Vol 161 ◽

pp. 108048 ◽

Cited By ~ 1

Author(s):

Eftychia Papachatzopoulou ◽

Christos Chatzakis ◽

Irene Lambrinoudaki ◽

Konstantinos Panoulis ◽

Konstantinos Dinas ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Glucose Tolerance ◽

Gestational Diabetes Mellitus ◽

Oral Glucose Tolerance Test ◽

Pregnancy Outcomes ◽

Glucose Tolerance Test ◽

Tolerance Test ◽

Oral Glucose ◽

Oral Glucose Tolerance

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Oral glucose tolerance test and pregnancy outcomes

International Journal of Diabetes in Developing Countries ◽

10.4103/0973-3930.37040 ◽

2007 ◽

Vol 27 (3) ◽

pp. 73

Author(s):

AA Elnour ◽

JC McElnay

Keyword(s):

Glucose Tolerance ◽

Oral Glucose Tolerance Test ◽

Pregnancy Outcomes ◽

Glucose Tolerance Test ◽

Tolerance Test ◽

Oral Glucose ◽

Oral Glucose Tolerance

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Developing twin‐specific 75g oral glucose tolerance test diagnostic thresholds for gestational diabetes based on the risk of future maternal diabetes: a population‐based cohort study

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/1471-0528.16773 ◽

2021 ◽

Author(s):

Liran Hiersch ◽

Baiju R. Shah ◽

Howard Berger ◽

Michael Geary ◽

Sarah D. McDonald ◽

...

Keyword(s):

Cohort Study ◽

Gestational Diabetes ◽

Glucose Tolerance ◽

Glucose Tolerance Test ◽

Maternal Diabetes ◽

Tolerance Test ◽

Population Based ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

Diagnostic Thresholds

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Comment on Pareek et al. Enhanced Predictive Capability of a 1-Hour Oral Glucose Tolerance Test: A Prospective Population-Based Cohort Study. Diabetes Care 2018;41:171–177

Diabetes Care ◽

10.2337/dc17-2714 ◽

2018 ◽

Vol 41 (5) ◽

pp. e81-e81

Author(s):

Lois Jovanovič

Keyword(s):

Cohort Study ◽

Glucose Tolerance ◽

Oral Glucose Tolerance Test ◽

Diabetes Care ◽

Glucose Tolerance Test ◽

Tolerance Test ◽

Population Based ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

Predictive Capability

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Single Fasting Plasma Glucose Versus 75-g Oral Glucose-Tolerance Test in Prediction of Adverse Perinatal Outcomes: A Cohort Study

EBioMedicine ◽

10.1016/j.ebiom.2017.01.025 ◽

2017 ◽

Vol 16 ◽

pp. 284-291 ◽

Cited By ~ 9

Author(s):

Songying Shen ◽

Jinhua Lu ◽

Lifang Zhang ◽

Jianrong He ◽

Weidong Li ◽

...

Keyword(s):

Cohort Study ◽

Glucose Tolerance ◽

Oral Glucose Tolerance Test ◽

Plasma Glucose ◽

Glucose Tolerance Test ◽

Perinatal Outcomes ◽

Tolerance Test ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

Adverse Perinatal Outcomes

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Rationale and Study Design of a Randomized Clinical Trial of Metformin to Prevent Frailty in Older Adults With Prediabetes

The Journals of Gerontology Series A ◽

10.1093/gerona/glz078 ◽

2019 ◽

Vol 75 (1) ◽

pp. 102-109 ◽

Cited By ~ 6

Author(s):

Sara E Espinoza ◽

Nicolas Musi ◽

Chen-pin Wang ◽

Joel Michalek ◽

Beverly Orsak ◽

...

Keyword(s):

Older Adults ◽

Clinical Trial ◽

Insulin Sensitivity ◽

Glucose Tolerance ◽

Oral Glucose Tolerance Test ◽

Glucose Tolerance Test ◽

Tolerance Test ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

Secondary Outcomes

Abstract Background Frailty is a geriatric syndrome that leads to poor health outcomes with aging. Previous studies have demonstrated that insulin resistance and inflammation predict frailty onset. Metformin is a widely used, well-tolerated drug that improves insulin sensitivity and displays anti-inflammatory properties. It is also known to prevent diabetes onset in adults with prediabetes. We hypothesize that metformin in older adults with prediabetes will promote healthy aging and prevent frailty. Here we describe an ongoing placebo-controlled, double-blinded clinical trial of metformin for the prevention of frailty in older adults with prediabetes. Methods Older adults aged more than 65 years are randomized to metformin or placebo and are followed for 2 years. Prediabetes, required for inclusion, is assessed by 2-hour oral glucose tolerance test. Exclusion criteria are baseline frailty (Fried criteria), diabetes, dementia, untreated depression, active malignancy, or severe cardiovascular, pulmonary, and neurologic diseases. Primary outcome is frailty; secondary outcomes are physical function (Short Physical Performance Battery), systemic and skeletal muscle tissue inflammation, muscle insulin signaling, insulin sensitivity (insulin clamp), glucose tolerance (oral glucose tolerance test), and body composition (dual-energy x-ray absorptiometry). Subjects are followed every 3 months for safety assessments and every 6 months for frailty assessment (Fried criteria) and oral glucose tolerance test, and every 12 or 24 months for secondary outcomes. Enrollment of 120 subjects (completers) will take place over a 2-year period. Conclusion Metformin is being examined in this study as a potential therapeutic agent to prevent frailty in older adults with prediabetes. Findings from this trial may have future implications for the screening and potential treatment of prediabetes in older patients with metformin for the prevention of frailty.

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