Fructosamine as a Screening Test for Gestational Daibetes
A 2 step testing at 24-28 weeks is recommended by organizations such as American College of Obstretics and Gynaecology.
1. Plasma Determination at 1 hour following ingestion of glucose liquid 50 g at any time of the day irrespective of theprior meal
2. Oral Glucose Tolerance Test for 3 hours following the ingestion of 100 g glucose post an overnight fast.
Further American Diabetes Association suggests 1 step testing. A 2 hour OGTT following consumption of 75 g glucose post an overnight fast. Several women are afraid to get tested since this procedure causes them nausea. The case report titled “Fructosamine as a Screening Test for Diabetes” was put forth by Udaya M Kabadil and colleagues and the summary has been given below.
Diagnosis:
A 37 year old was tested for GDM in a routine follow-up but she immediately developed nausea post the ingestion of glucose and thereby promptly denied to take another test. On her insisting, Dr. Kabadil recommended an HbA1c (average glucose: 3 months) test and a serum fructosamine test (average glucose: 3 weeks)
Results:
The HbA1c, Serum Fructosamine and Fasting plasma glucose as well as Free T3, T4 and TSH were within the normal range. Blood sugar levels reported were normal.
Treatment:
A blood test was performed to send blood for evaluating HbA1c and Serum T3 and T4 levels. A continuous glucose monitoring device was attached on the lateral side of her upper arm lasting for 10 days.
The highlight of the case study is that Oral glucose tolerance is an outdated procedure and now HbA1c and serum fructosamine help report better outcomes. Many women in gestation report nausea and hence taking this test adds inconvenience. The results of CGMS were in line with HbA1c and serum fructosamine test. Futhermore, fructosamine tests require no fasting and are more sensitive than HbA1c and studies are in progress to examine the utility of HbA1c and serum fructosamine by carrying out the comparative analysis between these tests and the 2 step testing recommended by ACOG.
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