1,596 research outputs found
Establishing Trimester-Specific Hemoglobin A1c Reference Levels for Pregnant Women: A retrospective study among healthy South Asian women with normal pregnancy outcomes
Objectives: This study aimed to define trimester-specific hemoglobin A1c (A1c) reference intervals among healthy South Asian pregnant women. Methods: In this restrospective study,1357 pregnant women without diabetes, gestational diabetes, gestational hypertension, anemia, Ξ²-thalassemia, or systemic diseases were included. They had term delivery of babies having weight appropriate for gestational age. A1c (using high performance liquid chromatography, meeting the National Glycohemoglobin Standardization Program and International Federation of Clinical Chemistry standards), hemoglobin, and RBC indices were estimated at the first antenatal visit. The A1c levels were calculated in terms of non-parametric 2.5 and 97.5 percentiles for women in first (T1), second (T2), and third (T3) trimester groups. The control group included 67 healthy non-pregnant women. Statistical tests were used to obtain the normal the normal reference values for the HbA1c . and the tests were considered significant when p value <0.05. Results: The median HbA1c (2.5 to 97.5 percentiles) was lower among the pregnant women; 4.8 (4-5.5) % or 32 (20-39) mmol/mol than in the non pregnant women; 5.1 (4-5.7) % or 29 (20-37) mmol/mol ( p <0.001). These were 4.9 (4.1-5.5) % or 30 (21-37) mmol/mol, 4.8 (4-5.3) % or 29 (20-34) mmol/mol, and 4.8 (3.9-5.6) % or 29 (19-38) mmol/mol for the T1, T2 and T3 groups, respectively; p-values:T1 vs T2=<0.001, T1 vs T3= 0.002, T2 vs T3= 0.111, T1 vs non pregnant group = <0.001. Conclusions: Compared to normal non pregnant women, the A1c was lower in normal pregnant women in South Asian population. These A1c changes were observed despite having significantly higher body max index among women in the T2 and T3 groups than in the T1 and non pregnant groups. To understand the factors determining the A1c decrease in pregnancy and to validate the findings of this study, we recommend further prospective studies among South Asian womenKeywords: Asian, Gestational diabetes, HbA1c , Pregnancy trimesters, Reference values
The accuracy of haemoglobin A1c as a screening and diagnostic test for gestational diabetes: a systematic review and meta-analysis of test accuracy studies
PURPOSE OF REVIEW: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy complications. Accurate screening and diagnosis of gestational diabetes are critical to treatment, and in a pandemic scenario like coronavirus disease 2019 needing a simple test that minimises prolonged hospital stay. We undertook a meta-analysis on the screening and diagnostic accuracy of the haemoglobin A1c (HbA1c) test in women with and without risk factors for gestational diabetes. RECENT FINDINGS: Unlike the oral glucose tolerance test, the HbA1c test is simple, quick and more acceptable. There is a growing body of evidence on the accuracy of HbA1c as a screening and diagnostic test for GDM. We searched Medline, Embase and Cochrane Library and selected relevant studies. Accuracy data for different thresholds within the final 23 included studies (16β921 women) were pooled using a multiple thresholds model. Summary accuracy indices were estimated by selecting an optimal threshold that optimises either sensitivity or specificity according to different scenarios. SUMMARY: HbA1c is more useful as a specific test at a cut-off of 5.7% (39βmmol/mol) with a false positive rate of 10%, but should be supplemented by a more sensitive test to detect women with GDM
Screening for Diabetes in At-Risk Populations in Primary Care: A Practice Guide
Diabetes mellitus (DM), a disease with far-reaching cardiovascular and physiological consequences, continues to grow at epidemic proportions despite efforts by the medical community to manage the disease, placing an enormous financial burden on the healthcare system. The Centers for Disease Control and Prevention released a report in 2014 reporting 29.1 million people in the United States have diabetes including 8.1 million undiagnosed cases. Colorado is one of eight states with the most significant increases in DM diagnoses, nearly doubling between 2003 and 2014. An estimated 300,000 adults have diabetes in Colorado and an estimated 110,000 more are undiagnosed (Colorado Department of Public Health and Environment, 2015). In the last three years, the American Diabetes Association (ADA; 2017), the World Health Organization (WHO; 2011b) and the U.S. Preventative Services Task Force (USPSTF; 2017) have released new recommendations on screening and diagnosing DM--all with nearly identical criteria; yet, these recommendations are rarely referenced or utilized. Glycosylated hemoglobin A1c (A1c) and fasting glucose levels are the most widely recognized tests for screening and managing diabetes and are included in the screening recommendations for the three largest organizations. To enhance the quality and consistency of diabetes screening practices in adults in the primary care setting, the purpose of this capstone project was to create a simple yet comprehensive clinical practice guideline utilizing fasting glucose levels and A1c as screening tests to aid providers at Park Avenue Medical Group in Ft. Lupton, Colorado. Two rounds of Delphi surveys were completed by expert provider participants to provide the foundation for the development of a clinical practice guideline in conjunction with current literature supported by the ADA (2017), WHO (2011b), and USPSTF (2017) and a retrospective study conducted as part of this research project. Five providers responded to the first round of surveys and four responded to the second round to elicit over an 80% response rate on the utility, comprehensiveness, and practical use of a diabetes screening guideline and algorithm. The results indicated a strong need for a discrete and comprehensive practice guideline. Data extracted from the retrospective study, literature review, and Delphi surveys were aggregated to develop the clinical practice guideline; through the use of the second Delphi survey, the guideline was refined to accommodate the provider participantsβ recommendations. In addition to the creation of a written guideline, an algorithm was designed that offered two clinical pathways depending on age to screen with an informal risk assessment and A1c at different intervals. Additional recommendations outside the scope of this capstone project were included to conduct a second post-implementation retrospective study after an initial pilot period. The Stetler (2001) model was used to translate the research for this project into practice utilizing a clinical practice guideline
Glycated albumin in pregnancy: LC-MS/MS-based reference interval in healthy, nulliparous Scandinavian women and its diagnostic accuracy in gestational diabetes mellitus
Glycated albumin (GA) may be a useful biomarker of glycemia in pregnancy. The aim of this study was to establish the reference interval (RI) for GA, analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS), in healthy, nulliparous pregnant women. In addition, we assessed the accuracy of GA and glycated hemoglobin A1c (HbA1c) in the diagnosis of gestational diabetes mellitus (GDM). Finally, we explored the prevalence of GDM in healthy nulliparas, comparing three diagnostic guidelines (WHO-1999, WHO-2013 and the Norwegian guideline). The study was carried out at Stavanger University Hospital, Norway, and included a study population of 147 pregnant nulliparous women. An oral glucose tolerance test (OGTT) was performed and used as the gold standard for GDM diagnosis. Blood samples for analysis of GA and HbA1c were collected at pregnancy week 24β28. A nonparametric approach was chosen for RI calculation, and receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of GA and HbA1c. The established RI for GA in 121 pregnant women was 7.1β11.6%. The area under the ROC curves (AUCs) were 0.531 (GA) and 0.627 (HbA1c). According to the WHO-1999, WHO-2013 and the Norwegian guideline, respectively, 24 (16%), 36 (24%) and 21 (14%) women were diagnosed with GDM. Only nine women (6%) fulfilled the GDM-criteria of all guidelines. In conclusion, we established the first LC-MS/MS-based RI for GA in pregnant women. At pregnancy weeks 24β28, neither GA nor HbA1c discriminated between those with and without GDM. Different women were diagnosed with GDM using the three guidelines.publishedVersio
Development and Evaluation of Protocol for Early Screening For Diabetes in Pregnancy: A Quality Improvement Initiative
Diabetes Mellitus is a dangerous condition known to cause adverse effects to both mother and fetus. Rates of diabetes are increasing worldwide. Research indicates that undiagnosed pre-existing, or overt, diabetes may increase poor outcomes in pregnancy; therefore, new recommendations from healthcare organizations endorse first-trimester screening for undiagnosed pre-existing diabetes in at-risk patients. Diabetes screening during pregnancy has long-been studied, and universal screening for gestational diabetes between 24 and 28 weeks gestation is endorsed by all major healthcare organizations. However, until recently, little research explored pre-existing diabetes and related effects on pregnancy. In 2018, the American College of Obstetricians and Gynecologists released new recommendations regarding screening at-risk patients in the first trimester of pregnancy. However, many providers have not yet begun to implement this testing. This project chronicles the development and evaluation of a protocol designed to identify and screen at-risk patients in the High-Risk Obstetrics clinic in an academic medical center located in a Midwestern city. After a review of the current literature, an evidence-based protocol for screening for overt diabetes in early pregnancy was developed. An inter-professional expert panel evaluated the protocol using the REDCap system, and the results were analyzed using qualitative and quantitative methods. Upon review and analysis, much of the evaluation results were positive, but some areas for improvement were clear. Evaluation was broken down by theme, to identify patterns in results. This information was then employed in developing a second, and final, draft of the Protocol. The response of a multi-professional provider review team supports adoption of this protocol; therefore, after making recommended alterations in format and content, this protocol will be considered for introduction in the High-Risk Obstetrics Clinic detailed in this document. Indicated follow-up study should include determining the early diagnosis rates of diabetes in pregnancy, as well as a cost analysis of the available methods of testing in early pregnancy. Keywords: diabetes, prenatal care, screening, protocol, diabetes in pregnancy, overt diabete
Early pregnancy HbA1c as the first screening test for gestational diabetes : results from three prospective cohorts
We acknowledge the huge number of staff in individual study centres, specific individuals (clinical and administrative) mentioned in the appendix (pp 14 1215 ) and all the participants who partook in the study and gave their valuable time. Our special thanks to Naveed Sattar for his feedback on the manuscript and help to improve it and to Nishanthi Periyathambi, a doctoral student at the University of Warwick, for help with some of the analysis on the revision.Peer reviewe
Diabetes mellitus: The epidemic of the century
The epidemic nature of diabetes mellitus in different
regions is reviewed. The Middle East and North Africa region has the highest prevalence of diabetes in
adults (10.9%) whereas, the Western Pacific region
has the highest number of adults diagnosed with
diabetes and has countries with the highest prevalence
of diabetes (37.5%). Different classes of diabetes
mellitus, type 1, type 2, gestational diabetes and other
types of diabetes mellitus are compared in terms of
diagnostic criteria, etiology and genetics. The molecular
genetics of diabetes received extensive attention in
recent years by many prominent investigators and
research groups in the biomedical field. A large array
of mutations and single nucleotide polymorphisms
in genes that play a role in the various steps and
pathways involved in glucose metabolism and the
development, control and function of pancreatic cells
at various levels are reviewed. The major advances in
the molecular understanding of diabetes in relation to
the different types of diabetes in comparison to the
previous understanding in this field are briefly reviewed
here. Despite the accumulation of extensive data at
the molecular and cellular levels, the mechanism of
diabetes development and complications are still not
fully understood. Definitely, more extensive research
is needed in this field that will eventually reflect on
the ultimate objective to improve diagnoses, therapy
and minimize the chance of chronic complications
development
Gestational diabetes: risks, management, and treatment options
Gestational diabetes mellitus (GDM) is commonly defined as glucose intolerance first recognized during pregnancy. Diagnostic criteria for GDM have changed over the decades, and several definitions are currently used; recent recommendations may increase the prevalence of GDM to as high as one of five pregnancies. Perinatal complications associated with GDM include hypertensive disorders, preterm delivery, shoulder dystocia, stillbirths, clinical neonatal hypoglycemia, hyperbilirubinemia, and cesarean deliveries. Postpartum complications include obesity and impaired glucose tolerance in the offspring and diabetes and cardiovascular disease in the mothers. Management strategies increasingly emphasize optimal management of fetal growth and weight. Monitoring of glucose, fetal stress, and fetal weight through ultrasound combined with maternal weight management, medical nutritional therapy, physical activity, and pharmacotherapy can decrease comorbidities associated with GDM. Consensus is lacking on ideal glucose targets, degree of caloric restriction and content, algorithms for pharmacotherapy, and in particular, the use of oral medications and insulin analogs in lieu of human insulin. Postpartum glucose screening and initiation of healthy lifestyle behaviors, including exercise, adequate fruit and vegetable intake, breastfeeding, and contraception, are encouraged to decrease rates of future glucose intolerance in mothers and offspring
Decreasing the Risk for Type II Diabetes After Gestational Diabetes: An Integrative Review
Abstract
Aim: This integrative review aimed to review studies on the risk of developing type II diabetes (T2DM) after a diagnosis of gestational diabetes mellitus (GDM) and available programs to mitigate this risk. The research question that guided this review was: For women diagnosed with gestational diabetes, what programs are available to decrease risk factors for developing T2DM later in life?
Background: Women who experience GDM have an increased risk of developing T2DM at a rate of eight times higher than those with no history of GDM (Song et al., 2017). The risk for T2DM after a diagnosis of GDM can be as high as 50% (Auvinen et al., 2020). Long-term morbidity and mortality can be decreased when women with a history of GDM are screened, and interventions are implemented postpartum (Uzoh et al., 2019). Modifiable risk factors can be reduced with early implementation of effective interventions (Goveia et al., 2018). Less than half of women with GDM receive appropriate diabetic screening and follow-up postpartum.
Methods: Articles were located by searching electronic databases including CINAHL, PubMed, Medline (MESH), Clinical Practice Guidelines (ACOG, ADA, CDC, AWHONN), Diabetes Prevention Project, US Preventative Services Taskforce, Gray Literature, Google Scholar, Hand search (JOGNN, NWH), Citation search, and Librarian support. Whittemore and Knaflβs (2005) framework for data collection and synthesis was utilized for this integrative review. Articles were reviewed from 2017 to December of 2022.
Results: This integrative review revealed seven studies related to available programs to implement diet and lifestyle modifications to reduce the risk of T2DM after a diagnosis of GDM. These studies research a variety of interventions including digital applications, video coaching, text support, virtual reality, or face to face sessions to evaluate program effectiveness. Themes found in the studies include weight loss, improved diet and calorie intake, and participant satisfaction. Barriers are often present in the achievement of lifestyle modifications as postpartum women experience fatigue and parenting stressors. Resolution of these barriers are a main focus of program development.
Conclusion: To reduce the risk of developing T2DM later in life, programs should be implemented that are patient centered with a focus on diet and lifestyle changes. Programs should allow for a variety of digital applications as well as in person sessions and should address barriers that would prevent goal achievement and maternal self-efficacy.
Keywords: diabetes in pregnancy, gestational diabetes, risk for type II diabetes in women with gestational diabetes, systematic review and gestational diabetes, integrative review and gestational diabetes, diabetes testing in the postpartum period, diabetes in the postpartum perio
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