Dear Editor,
In the Editorial Gestational diabetes mellitus: why screen and how to diagnose published in Hippokratia Vol 14, No 3 (2010) the authors1 present recent literature about the significance of recognition and glycemia control in women with gestational diabetes mellitus (GDM).
Indeed the International Association of Diabetes and Pregnancy Groups (IADPSG)2 proposed new values for 75 gr oral glucose tolerance test (OGTT) plasma glucose concentration of 92 for fasting, 180 one-hour and 153 mg/dl twohour after glucose load. These values were based on the results of Hyperglycemia and Adverse Pregnancy Outcomes ( HAPO) study and differ only minimally from values proposed by ADA3 (95 fasting, 180 one-hour and 155 mg/dl twohour after 75 gr glucose load).
The most important difference between IADPSG and ADA is that according to IADPSG criteria only one value of glucose above the normal range is sufficient for the diagnosis of gestational diabetes. It is not necessary therefore to perform OGTT in women with fasting plasma glucose above 92 mg/dl OGTT. This strategy is implemented in Diabetes Centre in Hippokratio Hospital in Thessaloniki; in addition we do not perform the 50 glucose load test as a screening test for GDM because, with this test, it is not possible to recognize all women with GDM.
Recently Agarwal et al4 determined the impact of IADPSG criteria on GDM diagnosis compared to the ADA criteria and the fasting plasma glucose to predict GDM. The IADPSG criteria increased GDM prevalence nearly threefold. However the cost- effectiveness of this strategy has not been answered yet and it should be determined in the future.
References
- 1.Karagiannis T, Bekiari E, Manolopoulos K, Paletas K, Tsapas A. Gestational diabetes mellitus: why screen and how to diagnose. Hippokratia. 2010;14:151–154. [PMC free article] [PubMed] [Google Scholar]
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- 3.American Diabetes Association Standards of medical care in diabetes- 2010. Diabetes Care. 2010;33:S11–S61. doi: 10.2337/dc10-S011. [DOI] [PMC free article] [PubMed] [Google Scholar]
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