Gestational diabetes: Using a portable glucometer to simplify the approach to screening

Background: In populations at a high-risk for gestational diabetes (GDM), the recommendation of screening every pregnant woman with the oral glucose tolerance test (OGTT) is very demanding. Aim: To assess the usefulness of the portable, plasma optimized glucometer in simplifying the approach to screening of GDM. Methods: 1,662 pregnant women underwent the one-step 75 g OGTT for routine screening of GDM, as defined by the criteria of the American Diabetes Association. The glucometer was used to measure the initial fasting venous whole blood glucose (FBG) to assess its value as a screening test in predicting the need to proceed with the OGTT. Results: 186 (11.2%) women had GDM. The area under the receiver operating characteristic curve (AUC) of the FBG was 0.876 (95% CI 0.847-0.906). A FBG threshold (at an acceptable sensitivity of 85%) independently could 'rule-out' GDM in 1,138 (68.5%) women; i.e. over two-thirds of the women would not need to continue with the cumbersome OGTT. Conclusions: Using the glucometer to initially measure the venous FBG as a screen can help to significantly reduce the number of OGTTs needed for the diagnosis of GDM. This algorithm offers a simple, practical, cost-effective and patient-friendly approach for the screening of GDM.