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Range of diagnostic criteria for gestational diabetes

Approach Criteria* Fasting

mg/dL

One-hour

mg/dL

Two-hour

mg/dL

Three-

hour

mg/dL

Two step (100-

gram load)

Carpenter

and Coustan

95 (5.3

mmol/L)

180 (10.0

mmol/L)

155 (8.6

mmol/L)

140 (7.8

mmol/L)

NDDG 105 (5.8

mmol/L)

190 (10.6

mmol/L)

165 (9.2

mmol/L)

145 (8.0

mmol/L)

Two step (75-

gram load)

CDA 95 (5.3

mmol/L)

191 (10.6

mmol/L)

160 (8.9

mmol/L)

One step (75-

gram load)

WHO 92 to 125

(5.1 to 6.9

mmol/L)

180 (10.0

mmol/L)

153 to 199

(8.5 to 11

mmol/L)

IADPSG 92 to 125(5.1 mmol/L)

180 (10.0mmol/L)

153 (8.5mmol/L)

These thresholds are for diagnosis of gestational diabetes. Diagnosis of overt diabetes and

diabetes in pregnancy are based on different criteria (eg, IADPSG: fasting blood glucose ≥126

mg/dL [7.0 mmol/L] is consistent with overt diabetes; WHO: two-hour glucose ≥200 mg/dL

[11.1 mmol/L] following a 75-gram oral glucose load is consistent with diabetes in

pregnancy).

NDDG: National Diabetes Data Group; CDA: Canadian Diabetes Association; WHO: World Health

Organization; IADPSG: International Association of Diabetes and Pregnancy Study Groups.

Data from: Vandorsten JP, Dodson WC, Espeland MA, et al. National Institutes of Health consensus

development conference: diagnosing gestational diabetes mellitus. NIH Consens State Sci Statements

2013; 29:1.

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Diagnostic criteria for the 100-gram three-hour GTT to diagnose

gestational diabetes mellitus

Plasma or serum glucose

level

Carpenter/Coustan

Plasma level

National Diabetes Data

Group

mg/dL mmol/L mg/dL mmol/L

Fasting 95 5.3 105 5.8

One hour 180 10.0 190 10.6

Two hours 155 8.6 165 9.2

Three hours 140 7.8 145 8.0

100-gram oral glucose load is given in the morning to a patient who has fasted overnight for

at least 8 hours. Glucose concentration greater than or equal to these values at TWO or more

time points is a positive test.

Two different classification schemes of GDM based upon results of the three-hour GTT results

have been proposed. The Fourth International Workshop-Conference on Gestational Diabetes

GTT values cited above are based upon the Carpenter and Coustan modification of earlier

values. They are lower than those proposed by the Expert Committee on the Diagnosis and

Classification of Diabetes Mellitus and the National Diabetes Data Group (NDDG), which used

cutoff values of 105, 190, 165, and 145 mg/dL (5.8, 10.6, 9.2, and 8.0 mmol/L), respectively.

The values are lower because the thresholds derived from the older Somogyi-Nelson method

of glucose analysis were corrected to account for the enzymatic assays currently in use.

GTT: glucose tolerance test.

Data from: VanDorsten JP, Dodson WC, Espeland MA, et al. National Institutes of Health Consensus

Development Conference Statement: Diagnosing Gestational Diabetes Mellitus. NIH Consens State Sci

Statements 2013; 29:1.

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IADPSG and ADA criteria for a positive two-hour 75-gram oral

glucose tolerance test for the diagnosis of gestational diabetes

Two hour 75-gram oral glucose tolerance test

Fasting ≥92 mg/dL (5.1 mmol/L)

OR

One-hour ≥180 mg/dL (10.0 mmol/L)

OR

Two-hour ≥153 mg/dL (8.5 mmol/L)

The diagnosis of gestational diabetes is made at 24 to 28 weeks of gestation when one or

more plasma glucose values meets or exceeds the above values.

ADA: American Diabetes Association; IADPSG: International Association of the Diabetes and Pregnancy

Study Groups.

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ADA criteria for the diagnosis of diabetes

1. A1C ≥6.5 percent. The test should be performed in a laboratory using a method that is NGSP

certified and standardized to the DCCT assay.*

OR

2. FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least eight hours.*

OR

3. Two-hour plasma glucose ≥200 mg/dL (11.1 mmol/L) during an OGTT. The test should be

performed as described by the World Health Organization, using a glucose load containing the

equivalent of 75-gram anhydrous glucose dissolved in water.*

OR

4. In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma

glucose ≥200 mg/dL (11.1 mmol/L).

A1C: glycated hemoglobin; DCCT: diabetes control and complications trial; FPG: fasting plasma glucose;

NGSP: national glycohemoglobin standardization program; OGTT: oral glucose tolerance test.* In the absence of unequivocal hyperglycemia, criteria 1 to 3 should be confirmed by repeat testing.

Reprinted with permission from: American Diabetes Association. Standards of Medical Care in Diabetes

2011. Diabetes Care 2011; 34:S11. Copyright © 2011 American Diabetes Association.

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ACOG two step approach for screening and diagnosis of gestational

diabetes

Step one

1. Give 50-gram oral glucose load without regard to time of day

2. Measure plasma or serum glucose

3. Glucose ≥135 mg/dL (7.5 mmol/L) or ≥140 mg/dL (7.8 mmol/L) is elevated and requires

administration of a 100-gram oral glucose tolerance test*. The lower threshold provides greater

sensitivity, but would result in more false positives and would require administering the full

glucose tolerance test to more patients than the 140 mg/dL threshold. The lower threshold

should be considered in populations with higher prevalence of gestational diabetes.

Step two

1. Measure fasting serum or plasma glucose concentration

2. Give 100-gram oral glucose load

3. Measure plasma or serum glucose at one, two, and three hours after glucose load

4. A positive test is defined by elevated glucose concentrations at two or more time points

(either Carpenter and Coustan thresholds or National Diabetes Data Group thresholds can be

used)

*Some experts use a threshold of 130 mg/dL (7.2 mmol/L)

Data from: American College of Obstetricians and Gynecologists. Practice Bulletin number 137:

Gestational diabetes. Obstet Gynecol 2013; 122:406.

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World Health Organization (WHO) thresholds for positive two-hour

75-gram oral GTT (2013). A diagnosis of "gestational diabetes

mellitus" is made when one or more of the following

glucose thresholds is met any time during pregnancy.

Fasting 9 2 to 125 mg/dL (5 .1 to 6 .9 mmol/L )

OR

On e-h our ≥1 80 mg/dL (10.0 mmol/L)

OR

Two-hour 153 to 199 mg/dL (8.5 to 11.0 mmol/L)

By comparison, a diagnosis of "diabetes mellitus in pregnancy" is made if one or more of the

following criteria are met: fasting plasma glucose ≥126 mg/dL (7.0 mmol/L), two hour plasma

glucose ≥200 mg/dL (11.1 mmol/L) following a 75 gram oral glucose load, random blood

glucose ≥200 mg/dL (11.1 mmol/L) in the presence of diabetes symptoms. There are no

established criteria for the diagnosis of "diabetes mellitus in pregnancy" based on the 1-hour

post-load value.

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