Candy twists as an alternative to the glucola beverage in gestational diabetes mellitus screening

Oral Glucose Tolerance Testing Using Candy: A Sweet Solution to Improve Screening in Children with Cystic Fibrosis?

INTRODUCTION

Oral glucose tolerance testing is recommended for all children with CF older than 9 years, yet compliance remains poor across centers.

METHODS

We performed a small pilot study assessing the glycemic curves and participant satisfaction in seven children and adolescents.

RESULTS

We chose a dextrose-based candy (Nerds®) free of any fat, fiber, gelatin, or corn syrup and performed the candy OGTT 1-4 days following the standard oral dextrose solution OGTT. Glucose values at 120 min were similar between the candy and oral dextrose solution (p = 0.8986).

CONCLUSIONS

Our small pilot suggests that a carefully selected candy alternative may result in similar glycemic OGTT when compared to the standard oral dextrose solution. However, some participants preferred the oral dextrose solution to candy due to having to consume a large volume in a short period of time. This may have significant implications as centers consider candy alternatives to increase OGTT adherence rates.

Metabolic Effects of an Oral Glucose Tolerance Test Compared to the Mixed Meal Tolerance Tests: A Narrative Review

The oral glucose tolerance test (OGTT) is recommended for assessing abnormalities in glucose homeostasis. Recognised as the gold standard test for diagnosing diabetes, the OGTT provides useful information about glucose tolerance. However, it does not replicate the process of absorption and digestion of complex foods, such as that which occurs with a mixed meal tolerance test (MMTT), an alternative that is still not well explored in the diagnosis of metabolic alterations. The MMTT could be an asset in detecting glucose homeostasis disorders, including diabetes since it has more similarities to the common dietary pattern, allowing early detection of subtle changes in metabolic homeostasis in response to combined nutrients. This alternative has the advantage of being more tolerable and pleasant to patients since it induces a more gradual increase in blood glucose, thus reducing the risk of rebound hypoglycemia and other related complications. The present article reviewed the clinical data available regarding the possibility of screening or diagnosing altered glucose homeostasis, including type 2 diabetes mellitus, with the MMTT.

Diabetes screening in pregnancy failing women in rural Western Australia: An audit of oral glucose tolerance test completion rates

OBJECTIVE

To quantify screening rate for gestational diabetes mellitus and completion of oral glucose tolerance test in rural and remote Western Australia.

DESIGN AND PARTICIPANTS

Retrospective audit of 551 antenatal records from women of 16 years and older without pre-existing diabetes and with singleton pregnancies delivered in 2013.

MAIN OUTCOME MEASURES

Number of women recorded screened for gestational diabetes mellitus in second or third trimester using oral glucose tolerance test or other tests; gestational diabetes mellitus rate.

RESULTS

Only 278 (50.5%) women were screened with oral glucose tolerance test; 113 (20.5%) had no record of any screening related to gestational diabetes mellitus. In a nested mixed-effects logistic regression model, women with a previous gestational diabetes mellitus diagnosis, two or more risk factors (excluding ethnicity) or high-risk gestational diabetes mellitus ethnicity other than Australian Aboriginal were more likely to be screened, while Australian Aboriginal women were less likely to be screened with oral glucose tolerance test. Clinicians reported patient and clinician factors and logistical difficulties as reasons for the oral glucose tolerance test not being completed at their site. Of those screened with oral glucose tolerance test, a high rate of gestational diabetes mellitus was diagnosed (14.7% versus Western Australia state-wide average of 7.4%).

CONCLUSION

Adherence to oral glucose tolerance test screening in rural Western Australia is inadequate for effective screening for gestational diabetes mellitus. Screening was not acceptable or available for a significant proportion of women at risk. Efforts to improve oral glucose tolerance test adherence and exploration of alternative gestational diabetes mellitus screening strategies are required.

Choosing to Decline: Finding Common Ground through the Perspective of Shared Decision Making

Respectful communication is a key component of any clinical relationship. Shared decision making is the process of collaboration that occurs between a health care provider and patient in order to make health care decisions based upon the best available evidence and the individual's preferences. A midwife and woman (and her support persons) engage together to make health care decisions, using respectful communication that is based upon the best available evidence and the woman's preferences, values, and goals. Supporting a woman's autonomy, however, can be particularly challenging in maternity care when recommended treatments or interventions are declined. In the past, the real or perceived increased risk to a woman's health or that of her fetus as a result of that choice has occasionally resulted in coercion. Through the process of shared decision making, the woman's autonomy may be supported, including the choice to decline interventions. The case presented here demonstrates how a shared decision-making framework can support the health care provider-patient relationship in the context of informed refusal.

Using Ice Cream for Diagnosis of Diabetes Mellitus and Impaired Glucose Tolerance: An Alternative to the Oral Glucose Tolerance Test

BACKGROUND

Oral glucose tolerance test (OGTT) is a sensitive and reliable test for diabetes mellitus and impaired glucose tolerance (IGT). However, poor patient tolerance of glucose solutions is common. We aim to compare the diagnostic value of an ice cream test with a standard OGTT.

MATERIALS AND METHODS

A total of 104 healthy adults were randomly assigned to either 75-g OGTT or ice cream, followed by a crossover to the other test.

RESULTS

Most patients were females (71%). Mean age was 37 ± 12 years, and body mass index was 24.2 ± 3.9kg/m². Diabetes mellitus and IGT, as diagnosed by 75-g OGTT, were 4.8% and 6.7%, respectively. The 2-hour plasma glucose levels were 110 ± 55.5mg/dL with 75-g glucose and 97.52 ± 40.7mg/dL with ice cream. The correlation coefficient of 2-hour plasma glucose for the 2 tests was 0.82 (95% CI: 0.75-0.87; P < 0.001). Discordant diagnostic results, based on 2-hour plasma glucose levels, were 9.61%. By using a combination of fasting plasma glucose and 2-hour plasma glucose values, the ice cream test would have missed 5.76% of those at high risk for diabetes mellitus (impaired fasting glucose and IGT) or diabetes.

CONCLUSIONS

An ice cream test may serve as an alternative to a 75-g OGTT. Before applying this test in clinical practice, it needs to be validated in a larger population.

Single abnormal value on 3-hour oral glucose tolerance test during pregnancy is associated with adverse maternal and neonatal outcomes: a systematic review and metaanalysis

OBJECTIVE DATA

The purpose of this study was to determine whether women with 1 abnormal value on 3-hour 100-g oral glucose tolerance test are at an increased risk for adverse pregnancy outcomes.

STUDY

Gestational diabetes mellitus is diagnosed by a 2-step method, with a 3-hour, 100-g oral glucose tolerance test that is reserved for women with an abnormal 1-hour, 50-g glucose challenge test. Although the increased maternal-fetal morbidity with gestational diabetes mellitus is well established, controversy remains about the risk that is associated with an isolated abnormal value during a 3-hour, 100-g oral glucose tolerance test.

STUDY APPRAISAL AND SYNTHESIS METHODS

Prospective and retrospective studies that evaluated the maternal and perinatal impact of 1 abnormal glucose value during a 3-hour, 100-g oral glucose tolerance test were identified with the use of computerized databases. Data were extracted and quantitative analyses were performed.

RESULTS

Twenty-five studies (7 prospective and 18 retrospective) that met criteria for metaanalysis included 4466 women with 1 abnormal glucose value on oral glucose tolerance test. Patients with 1 abnormal glucose value had significantly worse pregnancy outcomes compared with women with zero abnormal values with the following pooled odds ratios: macrosomia, 1.59 (95% confidence interval, 1.16-2.19); large for gestational age, 1.38 (95% confidence interval, 1.09-1.76); increased mean birthweight, 44.5 g (95% confidence interval, 8.10-80.80 g); neonatal hypoglycemia, 1.88 (95% confidence interval, 1.05-3.38); total cesarean delivery, 1.69 (95% confidence interval, 1.40-2.05); pregnancy-induced hypertension, 1.55 (95% confidence interval, 1.31-1.83), and Apgar score of <7 at 5 minutes, 6.10 (95% confidence interval, 2.65-14.02). There was also an increase in neonatal intensive care unit admission and respiratory distress syndrome. Similar results were seen that compared 1 abnormal glucose value to a population with a normal 1-hour 50-g glucose challenge test (normal glucose screen). With the exception of birthweight, outcomes of patients with 1 abnormal glucose value were similar to outcomes of patients with gestational diabetes mellitus.

CONCLUSION

Women with 1 abnormal value on 3-hour, 100-g oral glucose tolerance test have a significantly increased risk for poor outcomes comparable with women who have gestational diabetes mellitus.