1432-P: Local Glucose Source for Gestational Diabetes Screening in Resource-Limited Settings

Background: In resource-limited settings, screening for gestational diabetes (GDM) is not routine. Standard commercial glucose preparations are often not available.

Objectives: To test a locally accessible, cheaper alternative glucose source (AGS) for GDM screening in Haiti.

Methods: Double cross-over trial of 138 pregnant women 24-28 weeks gestational age. Two one-step 75g oral glucose tolerance tests (oGTT) with capillary blood glucose (CBG) obtained at 0, 1 and 2h were performed 3-5 days apart with the standard glucose drink Glucola and with AGS. Each participant served as her own control. Logistic and linear regression were used to assess AGS-CBG as a predictor of GDM and of Glucola-CBG, respectively. Tolerance of AGS was surveyed.

Results: Fourteen women (10%) had GDM, and 5, 2, and 7 were diagnosed based on Glucola-CBG of >92, >180, and >163 mg/dl at 0, 1 and 2h, respectively. At 1 and 2h, mean AGS-CBG vs. Glucola-CBG was 107 vs. 126 (p<.0001) and 89 vs. 113 mg/dl (p<.0001), respectively, and they were positively correlated (r=0.65 and r=0.68, p≤0001). The 1h AGS-CBG had an area under the curve of 0.82 (p=0.0002) to predict GDM. A cut-off of ≥120 mg/dl had a sensitivity, specificity, positive and negative predictive value of 100%, 78%, 25% and 100% to predict GDM not diagnosed by a fasting CBG.

Conclusion: Using a fasting CBG of >92 mg/dL and a 1h post-AGS CBG of ≥120 mg/dL, AGS can determine the need for a Glucola-based oGTT, avoiding 3 out of 4 Glucola based tests. Women prefer AGS over Glucola.