Comparison of oral glucose tolerance test and ambulatory glycaemic profiles in pregnant women in Uganda with gestational diabetes using the FreeStyle Libre flash glucose monitoring system

BMC Pregnancy and Childbirth

A. G. Jones¹  E. Walugembe²  S. Ssentayi²  H. Nkabura²  J. M. Milln³  M. J. Nyirenda⁴ 

[1] National Institute for Health and Research (NIHR), Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK;Non-Communicable Diseases Theme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P. O. BOX 49, Plot 51-59, Nakiwogo Road, Entebbe, Uganda;Non-Communicable Diseases Theme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P. O. BOX 49, Plot 51-59, Nakiwogo Road, Entebbe, Uganda;Department of Endocrinology and Diabetes, Queen Mary University of London, Mile End Road, London, UK;Non-Communicable Diseases Theme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, P. O. BOX 49, Plot 51-59, Nakiwogo Road, Entebbe, Uganda;Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, UK;

关键词: Gestational diabetes;    Non-communicable disease;    Africa;    Sub-Saharan Africa;    Continuous glucose monitoring;    Oral glucose tolerance test;    Obstetric medicine;   

DOI  :  10.1186/s12884-020-03325-9

来源: Springer

【 摘 要 】

BackgroundThe diagnosis of hyperglycaemia in sub-Saharan Africa (SSA) is challenging. Blood glucose levels obtained during oral glucose tolerance test (OGTT) may not reflect home glycaemic profiles. We compare OGTT results with home glycaemic profiles obtained using the FreeStyle Libre continuous glucose monitoring device (FSL-CGM).MethodsTwenty-eight women (20 with gestational diabetes [GDM], 8 controls) were recruited following OGTT between 24 and 28 weeks of gestation. All women wore the FSL-CGM device for 48–96 h at home in early third trimester, and recorded a meal diary. OGTT was repeated on the final day of FSL-CGM recording. OGTT results were compared with ambulatory glycaemic variables, and repeat OGTT was undertaken whilst wearing FSL-CGM to determine accuracy of the device.ResultsFSL-CGM results were available for 27/28 women with mean data capture 92.8%. There were significant differences in the ambulatory fasting, post-prandial peaks, and mean glucose between controls in whom both primary and secondary OGTT was normal (n = 6) and those with two abnormal OGTTs or “true” GDM (n = 7). There was no difference in ambulatory mean glucose between these controls and the 13 women who had an abnormal primary OGTT and normal repeat OGTT. These participants had significantly lower body mass index (BMI) than the true GDM group (29.0 Vs 36.3 kg/m2, p-value 0.014).Paired OGTT/FSL-CGM readings revealed a Mean Absolute difference (MAD) -0.58 mmol/L and Mean Absolute Relative Difference (MARD) -11.9%. Bland-Altman plot suggests FSL-CGM underestimated blood glucose by approximately 0.78 mmol/L.ConclusionDiagnosis of GDM on a single OGTT identifies a proportion of women who do not have a significantly higher home glucose levels than controls. This raises questions about factors which may affect the reproducibility of OGTT in this population, including food insecurity and atypical phenotypes of diabetes. More investigation is needed to understand the suitability of the OGTT as a diagnostic test in sub-Saharan Africa.

【 授权许可】

CC BY