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Good glycemic control is the cornerstone of managing gestational diabetes (GDM). It is generally accepted that the earlier glycemic control is achieved, the better the outcome for mother and infant. We sought to determine whether using a 1-step method for screening and diagnosis of GDM leads to earlier glycemic control compared to the 2-step method.
A retrospective cohort study was performed by reviewing the charts of all patients with GDM enrolled in our Diabetes in Pregnancy Program (DIPP) from January 2009-May 2012. Before 10/2010, the 2-step method was used, with a 50-gm OGCT followed by a 100-gm OGTT. From 10/2010, the 75-gm OGTT 1-step method was used, as recommended by the American Diabetes Association. Patients were instructed to check fingerstick glucose with memory reflectance meters 4-7 times a day. Good glycemic control was defined as a mean glucose ≤ 100mg/dL over a period of 2 weeks. Failure to achieve good control with diet modification was followed by therapy with glyburide or insulin and doses were adjusted every week. The percent of patients who achieved good control was determined for the 1-step and 2-step groups at each gestational age. Statistical analysis was performed using Chi square and Student's t-test, as appropriate.
566 patients for whom detailed glucose control data were available were included in this study. 332 patients were diagnosed by the 2-step method and 234 were diagnosed by the 1-step method. Patients' demographic characteristics did not differ significantly between these two groups. Patients in the 1-step group achieved good glycemic control significantly earlier than those in the 2-step group (table 1). Additionally, a larger percent of patients in the 2-step group never achieved glycemic control compared to the 1-step group (p< 0.05).
1Percent of patients achieving good glycemic control
The 1-step method for the diagnosis of gestational diabetes leads to earlier glycemic control than the 2-step group.