Candy twists as an alternative to the glucola beverage in gestational diabetes mellitus screening

Am J Obstet Gynecol. 2015 Apr;212(4):522.e1-5. doi: 10.1016/j.ajog.2014.11.010. Epub 2014 Nov 13.


Objective: Screening for gestational diabetes mellitus commonly uses an oral glucose challenge test with a 50-g glucola beverage and subsequent venous puncture. However, up to 30% of pregnant women report significant side-effects, and the beverage is costly. We hypothesized that equivalent glucose loads could be achieved from a popular candy twist (Twizzlers; The Hershey Company, Hershey, PA) and tested it as cost-effective, tolerable alternative with a test of equivalency.

Study design: The glucose equivalent of the 50-g glucola was calculated as 10 candy twists. We initially used a triple crossover design in nonpregnant patients whereby each subject served as her own control; this ensured the safety and equivalency of this load before using it among pregnant subjects. We then recruited pregnant women with an abnormal screening at 1 hour (glucose challenge test) in a double crossover design study. Subjects consumed 10 candy twists with a 1-hour venous blood glucose assessment. All subjects subsequently completed the confirmatory 3-hour glucose tolerance test. Sensitivity, specificity, positive predictive values, negative predictive values, false-referral rates, and detection rates were calculated.

Results: At ≥130 mg/dL, the sensitivity (100%) was the same for candy twists and glucola. However, the false-referral rate (82% vs 90%), positive predictive value (18% vs 10%), and detection rate (18% vs 10%) were improved for candy twists when compared with the 50-g glucola beverage.

Conclusion: Our results indicate that strawberry-flavored candy twists are potentially an equally effective screening test, compared with the gold standard glucola beverage but lead to fewer false-positive screens and therefore could be a cost-effective alternative.

Keywords: diabetes mellitus; gestational diabetes mellitus; screening.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Beverages*
  • Candy*
  • Carbohydrates*
  • Cross-Over Studies
  • Diabetes, Gestational / diagnosis*
  • Female
  • Glucose Tolerance Test
  • Humans
  • Pregnancy
  • Sensitivity and Specificity
  • Single-Blind Method


  • Carbohydrates
  • Glucola