Oral glucose tolerance test to diagnose gestational diabetes mellitus: Impact of variations in specimen handling

Emma L Jamieson; Goce Dimeski; Robert Flatman; Peter E Hickman; Graham Ross Dallas Jones; Julia V Marley; H David McIntyre; Alan R McNeil; Christopher J Nolan; Julia M Potter; Arianne Sweeting; Peter Ward; Paul Williams; Andrea Rita Horvath

doi:10.1016/j.clinbiochem.2022.10.002

Oral glucose tolerance test to diagnose gestational diabetes mellitus: Impact of variations in specimen handling

Clin Biochem. 2023 May:115:33-48. doi: 10.1016/j.clinbiochem.2022.10.002. Epub 2022 Oct 13.

Authors

Affiliations

¹ The Rural Clinical School of Western Australia, Medical School, The University of Western Australia, Building 3 ECU Campus, Robertson Road, Bunbury, WA 6230, Australia. Electronic address: emma.jamieson@rcswa.edu.au.
² Pathology QLD, Chemical Pathology, Princess Alexandra Hospital, Ipswich Road, Wooloongabba, QLD 4102, Australia; Faculty of Medicine, The University of Queensland, Mayne Medical Building, 288 Herston Road, Herston, QLD 4006, Australia.
³ Sullivan Nicolaides Pathology, 24 Hurworth Street, Bowen Hills, QLD 4006, Australia.
⁴ ACT Pathology, Level 1, Building 10 Canberra Hospital, Gilmore Cres, Garran ACT, 2605, Australia.
⁵ Department of Chemical Pathology, SydPath, 438 Victoria Street Level 5 Suite 507A St Vincent's Clinic, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia; School of Clinical Medicine, Faculty of Medicine and Health, The University of New South Wales, UNSW, 18 High St, Kensington, NSW 2052, Australia.
⁶ The Rural Clinical School of Western Australia, Medical School, The University of Western Australia, 12 Napier Terrace, Broome, WA, 6725, Australia.
⁷ Mater Research, The University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia.
⁸ Dorevitch Pathology, 18 Banksia Street, Heidelberg, VIC 3084, Australia.
⁹ Australian National University Medical School, The Australian National University, Florey Building, 54 Mills Road, Acton, ACT 2601, Australia; Department of Endocrinology, The Canberra Hospital, Yamba Drive, Garran, ACT 2505, Australia.
¹⁰ ACT Pathology, Level 1, Building 10 Canberra Hospital, Gilmore Cres, Garran ACT, 2605, Australia; Australian National University Medical School, The Australian National University, Florey Building, 54 Mills Road, Acton, ACT 2601, Australia.
¹¹ Department of Endocrinology, Royal Prince Alfred Hospital, 6 West, Missenden Road, Camperdown, NSW 2006, Australia; Faculty of Medicine and Health, The University of Sydney, Science Road, Camperdown, NSW 2006, Australia.
¹² NSW Health Pathology, Department of Chemical Pathology, Pacific Highway, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
¹³ Greg Brown Department of Endocrinology, The University of Sydney, Level 3 West Charles Perkins Centre, John Hopkins Drive, Sydney, NSW 2006 Australia.
¹⁴ NSW Health Pathology, Department of Chemical Pathology, Level 4 Campus Centre, The Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia.

PMID: 36244469
DOI: 10.1016/j.clinbiochem.2022.10.002

Abstract

To improve birth outcomes, all pregnant women without known diabetes are recommended for an oral glucose tolerance test (OGTT) to screen for hyperglycaemia in pregnancy (diabetes in pregnancy or gestational diabetes mellitus (GDM)). This narrative review presents contemporary approaches to minimise preanalytical glycolysis in OGTT samples with a focus on GDM diagnosis using criteria derived from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. The challenges of implementing each approach across a diverse Australian healthcare setting were explored. Many Australian sites currently collect and transport OGTT samples at ambient temperature in sodium fluoride (NaF) tubes which is likely to lead to missed diagnosis of GDM in a significant proportion of cases. Alternative preanalytical solutions should be pragmatic and tailored to individual settings and as close as possible to the preanalytical conditions of the HAPO study for correct interpretation of OGTT results. Rapid centrifugation of barrier tubes to separate plasma could be suitable in urban settings provided time to centrifugation is strictly controlled. Tubes containing NaF and citrate could be useful for remote or resource poor settings with long delays to analysis but the impact on the interpretation of OGTT results should be carefully considered. Testing venous blood glucose at the point-of-care bypasses the need for glycolytic inhibition but requires careful selection of devices with robust analytical performance. Studies to evaluate the potential error of each solution compared to the HAPO protocol are required to assess the magnitude of misdiagnosis and inform clinicians regarding the potential impact on patient safety and healthcare costs.

Keywords: Australia; Gestational diabetes mellitus; Hyperglycaemia in pregnancy; Oral glucose tolerance test; Preanalytical glycolysis.

Publication types

Review

MeSH terms

Australia
Blood Glucose / analysis
Diabetes, Gestational* / diagnosis
Female
Glucose Tolerance Test
Humans
Hyperglycemia*
Pregnancy
Specimen Handling

Substances

Blood Glucose