Gestational diabetes screening of a multiethnic, high-risk population using glycated proteins

In populations with a high incidence of gestational diabetes (GDM), any for m of oral glucose testing for screening or diagnosis excessively strains th e health care system. We investigated the value of glycated proteins as pot ential screening tests in 430 pregnant women, i.e. protein corrected fructo samine (cFRUC) and hemoglobin Ale (HbA(1c)) both alone and in combination f or a GDM diagnosis confirmed by the 'gold standard' 100-g oral glucose tole rance test (OGTT). Two cut-off values were used for each test, the upper to rule in and the lower to rule out GDM. At the lower cut-off values for cFR UC of 210 mu mol/l and HbA(1c) of 5%, the sensitivities achieved were 92.2 and 92.1% while the negative predictive values were 88.9 and 86.9%, respect ively. The upper cut-off values did not achieve acceptable positive predict ive values to be useful for ruling in GDM. Screening of our multiethnic, hi gh-risk pregnant population with a combination of cFRUC and HbA(1c) on a si ngle fasting sample would have avoided the cumbersome OGTT (by ruling out G DM) in 37.9% women with only a 3.9% misclassification rate. This potentiall y simpler approach, though not universally applicable, would be clinically useful and more acceptable to patients in selected high-risk populations. ( C) 2001 Elsevier Science Ireland Ltd. All rights reserved.