Main Organiser

Julius Centre University of Malaya

Co-organiser

Department of Social and Preventive Medicine, Faculty of Medicine, University of Malay

Supported by

University of Malaya

HOW USEFUL IS RISK SCORING IN REDUCING THE NEED FOR GESTATIONAL DIABETES SCREENING?

Author

Gill PK, Choo WY, Bulgiba AM

Institution

University Malaya

Abstract

Objectives: Predicting gestational diabetes (GDM) by risk scoring is meant to improve the efficiency of screening. This study aimed to develop a risk score for GDM screening and determine its usefulness in a Malaysian population. The Glucose Challenge Test (GCT) is the screening test used in UMMC was also incorporated into the model.

Methods: Using a retrospective cohort of 1997 women, a predictive model was developed and validated on a separate set of 1000 patients. The efficiency of screening with risk scores was then compared to universal screening.

Results: Two models were derived, the first with GCT as one of the determinants and the second without the GCT. The first model had good calibration (p=0.59) and an excellent discriminative ability (AUC of 0.92). It was able to detect 97% of the GDM cases but reduction in OGTT testing was a mere 2-4%. The second model derived was well calibrated (p=0.80) with an AUC 0.74 (95% CI 0.71– 0.76). Different combinations of thresholds for the risk score produced a screening reduction between 26%-29% (Sensitivity- 86% compared to 97% from universal screening) in Strategy 1. Strategy 2 had no screening reduction but had a higher sensitivity of 95%.

Conclusion: The performance of the risk score was good but the screening reduction produced were not substantial enough to encourage the use of risk scoring in clinical practice. Therefore its usefulness in our population is of limited value.