Forbes J Med. 2023; 4(2): 224-229 | DOI: 10.4274/forbes.galenos.2023.69077

Gestational Diabetes Screen One or Two-step Approach?

Behzat CAN¹, Kemal Hansu^2
1Kahramanmaraþ City Hospital, Clinic of Gynecological Oncology, Kahramanmaraþ, Turkey
²Kahramanmaraþ City Hospital, Clinic of Obstetrics and Gynecology, Kahramanmaraþ, Turkey

Objective: We aimed to compare the prevalence of gestational diabetes mellitus (GDM) according to one and two-step approaches in pregnant women and contribute to the national literature by determining which approach would be more beneficial for such women.
Methods: Our study included patients aged 15-45 years who were admitted to our hospital during their 24th-28th gestational weeks of pregnancies between January 2012 and December 2021. Participants were classified into five groups according to age: <25, 25-29, 30-34, 35-39, and more than 40 years. The prevalence of GDM in each group was separately calculated according to the results of the tests.
Results: Overall, 22,743 patients were included in the study. Of these, 2217 patients underwent a one-step 75-gram oral glucose tolerance test (OGTT). One hundred six patients could not tolerate the test, and the prevalence of GDM was 29.7% in 2111 patients who completed the test. Conversely, 20,526 patients underwent 50-gram OGTT, and the glucose level of 5761 (28%) patients was ≥140 mg/dL. A 3-hour 100- gram OGTT was performed for 2870 patients whose test results were positive. When the results of 2807 patients who completed the test were evaluated, the prevalence of GDM was found to be 3.1%.
Conclusion: The one-step approach significantly increases the prevalence of GDM compared with the two-step approach, and in the two-step approach, the diagnostic test can be skipped because the patients do not regularly undergo follow-up examinations. The results suggest that the one-step approach is more appropriate in societies that do not regularly attend follow-up visits.

Keywords: Gestational diabetes mellitus, oral glucose tolerance test, screening

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Gestasyonel Diyabet Taramasý: Tek Adýmlý Yaklaþým mý? Ýki Adýmlý Yaklaþým mý?

Behzat CAN¹, Kemal Hansu^2
1Kahramanmaraþ Necip Fazýl Þehir Hastanesi, Jinekolojik Onkoloji Bölümü, Kahramanmaraþ
²Kahramanmaraþ Necip Fazýl Þehir Hastanesi, Kadýn Hastalýklarý ve Doðum Bölümü, Kahramanmaraþ

Amaç: Kliniðimize baþvuran gebelerde gestasyonel diabetes mellitus (GDM) prevalansýný bir ve iki aþamalý yaklaþýmlara göre karþýlaþtýrmayý ve bu kadýnlar için hangi yaklaþýmýn daha faydalý olacaðýný belirleyerek ulusal literatüre katkýda bulunmayý amaçladýk.
Yöntem: Çalýþmamýza Ocak 2012-Aralýk 2021 tarihleri arasýnda hastanemize 24.-28. gebelik haftalarýnda baþvuran 15-45 yaþ arasý gebeler dahil edildi. Katýlýmcýlar yaþlarýna göre <25, 25-29, 30-34, 35-39 ve >40 yaþ olmak üzere beþ gruba ayrýldý. Her gruptaki GDM prevalansý, bir ve iki aþamalý tarama testlerinin sonuçlarýna göre ayrý ayrý hesaplandý.
Bulgular: Çalýþmamýza 15-45 yaþ arasý 22.743 hasta dahil edildi. Bunlardan 2217 hastaya tek aþamalý 75 gram oral glukoz tolerans testi uygulandý. Yüz altý hasta testi tolere edemedi, testi tamamlayan 2111 hastada GDM prevalansý %29,7 olarak bulundu. Buna karþýlýk 20.526 hastaya 50 gram glukoz tarama testi uygulandý ve 5761 (%28) hastanýn glukoz düzeyi ≥140 mg/dL idi. Test sonucu pozitif olan 2870 hastaya 3 saatlik 100 gram oral glukoz tolerans testi uygulandý. Testi tamamlayan 2807 hastanýn sonuçlarý deðerlendirildiðinde GDM prevalansý %3,1 olarak bulundu.
Sonuç: Tek aþamalý yaklaþým, iki aþamalý yaklaþýma göre GDM prevalansýný anlamlý olarak artýrmakta ve iki aþamalý yaklaþýmda hastalar düzenli olarak kontrol muayenelerine uymadýklarý için tanýsal test atlanabilmektedir. Sonuçlar, düzenli olarak takip muayenelerine katýlmayan toplumlarda tek adýmlý yaklaþýmýn daha uygun olduðunu göstermektedir.

Anahtar Kelimeler: Gestasyonel diabetes mellitus, oral glukoz tolerans testi, tarama

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