Background
The oral glucose tolerance test (OGTT) has been used for gestational diabetes mellitus (GDM) diagnosis for over 65 years1. Its poor acceptability has been repeatedly mentioned in literature2. Continuous glucose monitoring (CGM) is currently being considered a potential alternative to OGTT for GDM diagnosis3.
Purpose
Aim of our study was to formally assess women’s and health care professionals’ perception of OGTT and CGM as a diagnostic test for GDM.
Methods
A-hundred-and-six women participating to the Abbott pilot study on the use of the Freestyle Libre PRO 2 for GDM diagnosis, were invited to fill two online questionnaires on the acceptability of OGTT and CGM. Each questionnaire consisted of 6 Likert-scale questions and one optional open-ended question. Midwives, obstetricians, diabetes educator and endocrinologist where also invited to fill a questionnaire on their perception of both methods. The questionnaire consisted of 13 Likert scale-based questions and 7 optional open-ended questions.
Finding
Sixty women filled the questionnaire on OGTT and 70 that on CGM. OGTT glucose beverage and timeframe were reported as poorly acceptable by women. CGM was described by them as significantly more tolerable (82% vs 27% of 5/5 general acceptability rates, p<0.001). Among the participants, 93% would recommend CGM as a diagnostic test for GDM to other pregnant women. Thirty HCP completed the survey. Most of them (73%) had confidence in OGTT as a diagnostic test for GDM, while recognising (66%) that there are some issues with the current method of GDM diagnosis.
In the free text section on the OGTT, women defined it “such an inconvenience” and HCP an “unpleasant test that women do not want to do”. Most of the free comments on CGM were about the minimal impact on daily life: “didn’t even notice it” and women’s willingness of recommending this test over OGTT for GDM diagnosis. Doubts on CGM for GDM diagnosis were raised by HCP in terms of costs, accessibility and accuracy due to “lack of evidence for effectiveness in identifying the highest risk patients”.
Conclusions CGM could represent the solution to the many limits of OGTT for pregnant women while providing HCP with a better insight of their glucose homeostasis. Studies on correlation between CGM parameters and pregnancy outcomes and cost-analysis are needed to strengthen the role of CGM as diagnostic test for GDM.