In their comment letter, Mahdavian et al. (1) wonder about a wider application of our data (2) because, in a cohort of 459 pregnant women, their results were different. Mahdavian et al. have missed the very essence of our study, which was never meant to be a “fractional interpretation of IADPSG recommendations.” Also, nowhere do we question “the helpfulness of the full 2-h oral glucose tolerance test (OGTT).” On the contrary, we have categorically stated that the current IADPSG guidelines are based on sound scientific data and that they provide the solution to the desperately needed single approach to gestational diabetes mellitus (GDM) worldwide.
However, in our view, the only roadblock to universal application of the IADPSG may be the proposal to screen each and every pregnant woman with the OGTT. We have grappled with the current similar American Diabetes Association (ADA) recommendation—for high-risk populations—of using the one-step OGTT to screen all women for GDM; the two-step approach is not deemed to be cost-effective for such populations (3). Despite no dearth of financial resources, our constraint has been the physical demands on the laboratory of making every pregnant woman undergo the OGTT; thereby, to us these ADA recommendations have appeared to be an “ivory-tower” approach almost oblivious to realities on the ground.
Therefore, in order to implement the ADA guidelines, we have improvised by using the fasting plasma glucose (FPG). In our approach, we do not use the FPG to avoid the OGTT (as implied by Mahdavian et al.) but to predict which women may not need the OGTT. Our suggested algorithm is to let the pregnant woman come in fasting for an OGTT (which she has to, in any case), and based on the initial FPG value, she can avoid the OGTT. The misinterpretation of our study by Mahdavian et al. is obvious: they restrict their analysis of the OGTTs circumvented to the women with GDM (n = 43) instead of their entire cohort (n = 459). Furthermore, their numbers are too small to form any definite conclusions.
Finally, the lower FPG cutoff suggested by us is not cast in stone and could change from population to population: only data from other populations would clarify if one-size-fits-all. We agree that, with the IADPSG, we are finally beginning to see light at the end of the tunnel for a global guideline for GDM. As shown by our study (2), the FPG may make the bitter pill of “OGTT for all” a little easier to swallow—and without compromising health care.
Acknowledgments
No potential conflicts of interest relevant to this article were reported.
