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Re: RE HMOs and GTTsFrom: R. Daniel Braun (rBraun@IUNET.IUPUI.EDU)Sun Mar 31 07:05:18 1996
Let's please all use the same language so that we know what we are talking about. No one advocates routine screening GTT. GTT stands for GLUCOSE TOLERANCE TEST. This is a 3 hour test that must be performed after a three day high carbohydrate diet prep. It consists of obtaining a fasting blood sugar and then giving the patient 100 grams of glucose. The patient should not be allowed to ingest anything except water during the test. Smoking and physical activity also should be prohibited as they will lead to false positives the same as omitting the 3 day prep. 1 hour, 2 hours, and 3 hours after teh glucose ingestion, blood is drawn. At any time that the patient has symptoms of hypoglycemia, a blood sample is done. Until such time as somebody does a large study to determine the normal values for fingerstick whole blood samples, one MUST send these samples to the lab for plasma sugar determinations. If all teh above criteria are met, one can then use the published data for the diagnosis of gestational diabetes. The routine screening that is recommended is a single blood sugar drawn after a 50 gm. glucose load. The patient does not need to be fasting and in fact one study shows a higher number of false positives in patients who were fasting. If this value is above whatever cutoff you decide on based on sensitivity, specificity criteria, then the patient needs a GTT. If the patient has any of the classic indications of Dibetes ( previous macrosomic infant, direct family history of DM, previous GDM, signs or symptoms of DM, etc.) then one does not do the screen. The screen is only for patients who do not have those symptoms.
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