Comparison of diagnostic accuracy of two one step procedures for screening of gestational diabetes mellitus

Background: Single test procedures for screening GDM in Indian women will help in its management.This study was aimed to compare the accuracy measures of the random glucose test and the Diabetes In Pregnancy Study group India (DIPSI) recommended glucose challenge test as screening tests for Gestational Diabetes Mellitus (GDM) between 24 and 28 weeks of pregnancy and to study the prevalence of GDM and associated risk factors.Methods: In this prospective cohort study, all pregnant women without pre-existing diabetes underwent a random glucose test first followed by DIPSI recommended method (2 hours after a 75 g oral glucose load, without regard to the time of the last meal). All the pregnant women were subjected to 2-h 75-g oral glucose tolerance test for diagnosis of GDM within one week. Receiver Operating Characteristic (ROC) analysis was used to evaluate the discriminatory power of the two screening tests. Results: The OGTT was performed in 576 women. The area under the ROC curve was larger for the DIPSI test [0.97 (95% CI 0.95-0.98)] than for the random glucose test [0.76 (95% CI 0.72-0.79)]. There was a significant difference in the areas under the curve of the two tests of 0.21 (0.14 to 0.28) (P <0.0001) in favour of the DIPSI recommended method. GDM was present in 8.9% women confirmed by 75 g 2 hour OGTT using the WHO criteria. Age ≥30 years, BMI ≥25 and family history of diabetes were found to be risk factors for GDM.Conclusions: In screening for GDM, the DIPSI procedure test was more useful than the random glucose test