PSUN176 Fructosamine as a screening test for gestational diabetes

BACKGROUND: All organizations use variable glucose criteria for diagnosis of gestational diabetes (GDM). However all involve OGTT. American college of Obstetrics and Gynecology (ACOG) and American Diabetes Association (ADA) recommend 2 step testing; 1) 1 hour glucose level on 50 gm glucose ingestion at any time during the day (1 hour OGTT) and 2) 3 hour OGTT with 100 gm glucose ingestion after overnight fast in pregnant women with glucose > 140 mg/dl during 1 hour. OGTTs require preparation with least daily intake of carbohydrate 150 gm for 3 days before testing. Many women are hesitant getting tested because of nausea, vomiting on glucose ingestion. Thus, none of the tests is convenient. OBJECTIVE: We examined utility of serum Fructosamine level as a screening test for diagnosis of GDM. METHODS: Random serum glucose and Fructosamine (mcM/l) levels as well as HbA1c (%) were determined at 24-30 weeks in 206 pregnant women, ages 24-40 years along with 1 hour OGTT and then again with 3 hour OGTT in 46 pregnant women with abnormal 1 hour OGTT and 21 age matched non-pregnant women. Continuous glucose monitoring (CGM) for 2 weeks was performed in 5 pregnant women with abnormal 3 hour OGTT and 7 non-pregnant women. RESULTS: Fructosamine levels (192± 4) were significantly lower (p<0.01) in nondiabetic pregnant women when compared with age matched non-pregnant women (224 ± 5). Cutoff serum Fructosamine concentration between groups was 205. Glucose and HbA1c were not significantly different amongst groups. Serum Fructosamine levels in 26 pregnant with abnormal 1 hour but normal 3 hour OGTT were <205, similar to nondiabetic pregnant women. Serum Fructosamine concentrations in women with abnormal 3 hour OGTT and normal CGM e.g, 70-140 mg /dl matched levels in nondiabetic pregnant women. CONCLUSION: CGM may be the most accurate test for diagnosis of GDM. Random serum Fructosamine level may be as accurate as CGM and more accurate than both OGTTs. Importantly, it is a simple and convenient test without requiring fast, glucose ingestion or preparation. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.