Variations in the Prevalence of Gestational Diabetes Mellitus With Remote Testing and a Pragmatic Solution to Improve Accuracy.

A recent article (1) and Commentary (2) in Diabetes Care have raised issues with respect to the method of handling blood samples for oral glucose tolerance tests (OGTT) and the prevalence of gestational diabetes mellitus (GDM). Many Australian sites continue to rely solely on collection tubes containing fluoride for stabilization of glucose. In outback Australia, this is a very real issue. We previously estimated a two- to threefold increase in GDM prevalence in rural and remote Australia had the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study preanalytical protocol been used (from 10.8 to 28.5% [95% CI 20.8–29.5%]) (3). The impact of glycolysis is likely exacerbated in remote compared with urban settings due to greater distances to the laboratory—up to 650 km (400 miles) in our study (3). Centrifugation within 10 min of sample collection can achieve glucose profiles similar to those with the HAPO study preanalytical protocol (3). Potter et al. (1) found a 1.8-fold increase in GDM prevalence after pathology laboratory collection centers implemented immediate centrifugation in a predominantly urban Australian setting. However, many rural and remote sites in …