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Accuracy of screening tests for gestational diabetes mellitus in Southeast Asia: A systematic review of diagnostic test accuracy studies.

ABSTRACT: BACKGROUND:To investigate the accuracy of screening tests for gestational diabetes mellitus (GDM) in Southeast Asian pregnant women. METHODS:We searched PubMed (MEDLINE), Web of Science, Cochrane Library, ClinicalTrials.gov, Google Scholar, and Google for relevant articles published in English up to November 2018 using search terms related to GDM, screening tests for GDM and diagnostic performance. The studies were independently screened and selected by both authors. The methodological quality of the included studies was independently assessed by quality assessment of diagnostic accuracy studies 2. A hierarchical summary receiver operating characteristic (HSROC) model was created to estimate the HSROC curve. The summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated in a meta-analysis using bivariate random-effects model. RESULTS:A total of 19 studies were included in which the 100?g oral glucose tolerance test (OGTT) and 75?g OGTT were the two common reference standards for diagnosis of GDM. Most points of diagnostic performance in the HSROC 50?g GCT curve compared with the 100?g OGTT reference standard were clustered in the upper left-hand quadrant. The pooled sensitivity and specificity of the 50?g GCT were 79% (95% confidence interval [CI] 64%-89%) and 74% (95% CI 59%-85%), respectively. For the 75?g OGTT reference standard, the non-fasting 2-hour plasma glucose showed quite similar sensitivity the 50?g GCT compared with the 100?g OGTT reference standard. The pooled sensitivities and specificities of the fasting plasma glucose and hemoglobin A1c were 81% (95% CI 76%-86%) and 70% (95% CI 67%-72%), and 80% (95% CI 66%-90%) and 69% (95% CI 58%-78%), respectively. CONCLUSION:Our findings indicate that the 50?g GCT using the threshold of 140?mg/dL is a good screening test for identifying GDM at 24 to 28 weeks' gestational age for both high-risk and universal screening strategies in Southeast Asian countries. The non-fasting 2-hour PG, fasting plasma glucose or hemoglobin A1c are alternative choices for screening.

SUBMITTER: Lappharat S

PROVIDER: S-EPMC7668444 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Accuracy of screening tests for gestational diabetes mellitus in Southeast Asia: A systematic review of diagnostic test accuracy studies.

Lappharat Sattamat S Liabsuetrakul Tippawan T

Medicine 20201101 46

<h4>Background</h4>To investigate the accuracy of screening tests for gestational diabetes mellitus (GDM) in Southeast Asian pregnant women.<h4>Methods</h4>We searched PubMed (MEDLINE), Web of Science, Cochrane Library, ClinicalTrials.gov, Google Scholar, and Google for relevant articles published in English up to November 2018 using search terms related to GDM, screening tests for GDM and diagnostic performance. The studies were independently screened and selected by both authors. The methodolo ...[more]

PMID: 33181689

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Project description:Background and Aims: Cystic fibrosis-related liver disease (CFLD) is one of the leading causes of morbidity and mortality in cystic fibrosis (CF). Several non-invasive diagnostic methods have been proposed as screening tools for CFLD. Our aim was to rank all available non-invasive modalities for diagnostic performance. Methods: A systematic search was performed in five medical databases to find studies which reported on any single or composite non-invasive diagnostic test (as an index test) compared to the Debray, the EuroCare or the Colombo criteria (as a reference standard). Ranking was carried out with a Bayesian diagnostic test accuracy network meta-analysis based on superiority indices, calculated for pooled sensitivity (Se) and specificity (Sp) with a 95% confidence interval (CI). The study was registered under CRD42020155846 in PROSPERO. Results: Fifteen studies with 15 index tests and a combination of them were included. The New criteria proposed by Koh et al. - which represent a composite diagnostic definition for CFLD including liver biochemistry, ultrasonography, transient elastography and fibrosis markers-had the best performance for detecting CFLD (Se:94%[CI:58-100], Sp:72%[CI:52-84]); while transient elastography (Se:65%[CI:56-74], Sp:88%[CI:84-91]) and a combination of it with a tissue inhibitor of metalloproteinase-4 measurement (Se:78%[CI:30-100], Sp:64%[CI:18-95%]) proved to be the second and third best options, respectively. In the imaging techniques subgroup, transient elastography (Se:66%[CI:57-72], Sp:88%[CI:85-91%]), acoustic radiation force impulse in the right lobe (Se:54%[CI:33-74], Sp:88%[CI:66-96]) and that in the left lobe (Se:55%[CI:23-81], Sp:82%[CI:50-95]) were ranked the highest. Comparing biochemical markers/fibrosis indices, the measurement of the Forns index (Se:72%[CI:25-99], Sp:63%[CI:16-94]), the aspartate aminotransferase-to-platelet ratio (Se:55%[CI:41-68], Sp:83%[CI:66-89]) and alkaline phosphatase (Se:63%[CI:18-93], Sp:64%[CI:19-95]) were ranked the highest. Conclusion: The New criteria show the best diagnostic performance. In clinical practice, transient elastography seems to be a simple, cheap and non-invasive tool, outperforming imaging, biochemical and fibrosis tests for detecting CFLD. Further studies are needed to validate our findings.

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Accuracy of screening tests for gestational diabetes mellitus in Southeast Asia: A systematic review of diagnostic test accuracy studies.

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Accuracy of screening tests for gestational diabetes mellitus in Southeast Asia: A systematic review of diagnostic test accuracy studies.

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