RESUMO
Purpose: Few pregnant women in low-resource settings are screened for gestational diabetes mellitus (GDM) using the gold standard oral glucose tolerance test (OGTT). This study compared capillary blood glucose testing with 2-h plasma glucose measurements obtained using the 75-g OGTT to screen for GDM at primary healthcare clinics in Mexico. Patients and Methods: Pregnant women who participated in a previous prospective multicenter longitudinal cohort study and who had not been previously diagnosed with diabetes were included. Participants were evaluated using the plasmatic 2-h 75-g OGTT with simultaneous capillary blood glucose measurements using a glucometer. The study endpoint was the comparability of the glucometer results to the gold standard OGTT when collected simultaneously. Sensitivity, specificity, and area under the curve of the glucose measurements obtained for capillary blood compared with venous plasma (gold standard) were calculated to determine diagnostic accuracy. Results: The study included 947 pregnant women who had simultaneous glucose measurements available (blood capillary [glucometer] and venous blood OGTT). Overall, capillary blood glucose testing was very sensitive (89.47%); the specificity was 66.58% and the area under the curve (95% confidence interval) was 0.78 (0.74-0.81). The sensitivity, specificity and area under the curve of each capillary measurement were: 89.47%, 66.58% and 0.78 (0.74-0.82) for the fasting measurement, 91.53%, 93.24% and 0.92 (0.88-0.96) for the one-hour measurement, and 89.80%, 93.32%, 0.91 (0.87-0.95) for the second-hour measurement, respectively. No adverse events were reported. Conclusion: Capillary OGTT is a valid alternative to the gold standard OGTT for screening of GDM in low-resource situations or in situations where there are other limitations to performing the OGTT as part of primary healthcare services.
RESUMO
INTRODUCTION: cactus pear has been used in Mexican traditional medicine. However, clinical studies are limited to demonstrate the effectiveness as anti-diabetic. OBJECTIVE: to evaluate the effect of a fresh beverage made from Nopalea cochenillifera (l.) Salm-dyck on glucose levels, glycosylated hemoglobin, weight, waist circumference and blood pressure. METHODS: the beverage (50 g/250 mL) was daily administered in twenty patients for 30 days. RESULTS AND DISCUSSION: differences statistically significant were found in some time of the supplementation for all measured variables excepting for glucose levels, this suggests that values might be significant to a longer administration or bigger doses. CONCLUSIONS: although preliminary data, the results demonstrated that cactus pear used in this study may be an alternative for the management of patients with diabetes type 2. Nevertheless, further trials must be conducted with a bigger sample size and more control groups so that the effectiveness can be fully evaluated.
Introducción: el nopal ha sido usado en la medicina tradicional mexicana. Sin embargo, los estudios clínicos para demostrar la eficacia como antidiabético son limitados. Objetivo: evaluar el efecto de una bebida fresca a base de nopal (Nopalea cochenillifera (l.) Salm-dyck), sobre los niveles de glucosa, hemoglobina glicosilada, peso corporal, circunferencia de cintura y presión sanguínea. Métodos: la bebida (50 g/250 mL) se administró diariamente a 20 pacientes durante 30 días. Resultados y discusión: se encontraron diferencias estadísticamente significativas en algún momento de la suplementación, excepto para la glucosa, sugiriendo que los valores podrían ser significativos en un tiempo mayor de administración a dosis mayores. Conclusiones: aunque preliminares, los resultados demostraron que el nopal usado en este estudio podría ser útil en el manejo de pacientes con diabetes tipo 2. No obstante, deben efectuarse futuros ensayos con un tamaño de muestra más grande y más grupos control, para que la efectividad pueda ser totalmente evaluada.