Author(s): Sivan E, Weisz B, Homko CJ, Reece EA, Schiff E
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Abstract OBJECTIVE: This study was undertaken to compare the rate of abnormal glucose levels measured after 1 hour (>140 mg\%) with those measured after 2 hours (>120 mg\%) postprandially in women with gestational diabetes mellitus (GDM). STUDY DESIGN: Sixty-eight women were included in this study. All had GDM based on the criteria of Carpenter-Coustan. Women with fasting glucose levels of 105 mg\% or more were excluded from the study. All women were initially treated by diet. All women measured daily capillary blood glucose levels when fasting as well as 1 hour and 2 hours postprandially for 1 week, immediately after diagnosis of GDM. Glucose levels were obtained by memory-based glucometers. All women were followed in a specialized gestational-diabetes clinic throughout the pregnancy. Insulin therapy was started on an individual basis according to common clinical criteria. Epidemiologic and perinatal data were collected from medical charts. RESULTS: The average age of the women was 30.8 +/- 5.4 years. Thirty-five percent of participants were primipara. The mean gestational age at diagnosis was 28.8 +/- 5.4 weeks. Glucose measurements included 618 readings during fasting and 2730 either 1 hour or 2 hours postprandial. Rates of abnormal glucose (>95 mg\% when fasting; >140 mg\% 1 hour or >120 mg\% 2 hours after each meal) per person were the following: fasting, 27.1\% abnormal glucose measurements; postbreakfast, 22.4\% abnormal levels after 1 and 8.5\% after 2 hours (P < .01); postlunch, 16.4\% abnormal levels after 1 hour and 18.2\% after 2 hours (not significant); postdinner, 16.3\% abnormal levels after 1 hour and 30.1\% after 2 hours (P < .01). CONCLUSION: The rate of abnormal values was 2.5-fold greater 1 hour postbreakfast than 2 hours postbreakfast, in contrast to an opposite ratio of a 2-fold increase in the rate of abnormal values 2 hours postdinner versus 1 hour postdinner. Therefore, differential measurement (1 hour after breakfast and 2 hours after dinner) might impose stricter criteria for controlling blood glucose levels. Further clinical research should explore whether differential measurements might reduce the rate of diabetes-associated complications.
This article was published in Am J Obstet Gynecol
and referenced in Journal of Biometrics & Biostatistics