DefinePK

Research Objective

To assess the effectiveness of HbA1c as an indicator of Gestational Diabetes mellitus (GDM).

Methodology

Prospective cases control study conducted at Fauji Foundation Hospital Rawalpindi from March 2022 to October 2022. Pregnant females older than 18 years in their first trimester were included. Blood samples were collected to evaluate HbA1c levels. Oral glucose tolerance tests (OGTT) were performed in the first and second trimesters to correlate with HbA1c. GDM patients formed the cases group, and non-GDM pregnant women formed the control group. Data was analyzed using SPSS version 26. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic potential.

Methodology Flowchart

                        graph TD
    A["Recruit Pregnant Females > 18 years 1st Trimester"] --> B["Exclude: Pre-existing DM, Medical Conditions, Multiple Gestations, Incomplete Records, Non-consent"];
    B --> C["Collect 5ml Blood Sample for HbA1c"];
    C --> D["Perform OGTT 1st Trimester"];
    C --> E["Perform OGTT 2nd Trimester"];
    D --> F["Categorize into Cases"GDM" and Controls"Non-GDM""];
    E --> F;
    F --> G["Collect Other Relevant Information via Study Proforma"];
    G --> H["Analyze Data using SPSS v26"];
    H --> I["Perform ROC Analysis for Diagnostic Potential"];
    I --> J["Draw Conclusions on HbA1c Effectiveness"];                    

Discussion

The study highlights the potential of HbA1c as an early diagnostic tool for GDM, noting improvements in laboratory testing and standardization. While HbA1c shows promise, particularly with a specificity of 95% in the third trimester, its low sensitivity presents challenges for standardization as a sole pregnancy test. Further refinement and validation are needed for its universal adoption as a screening tool for GDM, especially considering potential ethnic variations in HbA1c levels.

Key Findings

Average HbA1c levels were higher in women with GDM compared to women without GDM. Patients aged 35-39 showed a higher prevalence of GDM with 73.2% sensitivity and 66.7% specificity at a cut-off value of 5.6% (31 mmol/mol). Significantly elevated HbA1c levels were observed in both the first and second trimesters in individuals diagnosed with GDM, with a test specificity of 95%.

Conclusion

HbA1c levels are significantly elevated in individuals diagnosed with GDM during the first and second trimesters, demonstrating high specificity. It is a valuable diagnostic tool for the early detection of GDM, offering a robust and specific method for identifying at-risk individuals. Further large-scale validation studies are recommended to support its incorporation into routine screening protocols for gestational diabetes.

Fact Check

1. Study Period: The study was conducted from March 2022 to October 2022. (Confirmed in the text).
2. Number of Participants: A total of 90 pregnant female patients were identified, with 45 in the GDM group and 45 in the control group. (Confirmed in the text).
3. Age Group Prevalence: Patients in the age group 35-39 showed a prevalence of gestational diabetes with 73.2% sensitivity and 66.7% specificity at a cut-off value of 5.6%. (Confirmed in the text).

Mind Map