Diagnosis of gestational diabetes mellitus in Asian-Indian women

Abstract

Objective:To assess the validity of Diabetes in Pregnancy Study Group India (DIPSI) guidelines, a modified version of the WHO criterion to diagnose gestational diabetes mellitus (GDM).Materials and Methods:A total of 1 463 consecutive pregnant women in the second and third trimester of pregnancy underwent 75 g oral glucose tolerance test (OGTT) and 2-h plasma glucose (PG) was measured by the glucose oxidase-peroxidase (GOD-POD) method. GDM was diagnosed with 2-h PG ≥ 7.8 mmol/L (WHO criteria) and the rest were classified as normal glucose tolerant (NGT) women. GDM women were advised medical nutrition therapy (MNT) for two weeks. Those who failed to reach the target glycemic level of FPG < 5.0 mmol/L and 2-h PG < 6.67 mmol/L with MNT were advised insulin. All of them were followed throughout pregnancy until delivery. Birth weight of 90th percentile (> 3.45 kg) in the neonates was considered as macrosomia (primary outcome).Results:The mean maternal age and body mass index were 23.60±3.32 years and 21.5±4.06 kg/m2 respectively. The mean gestational age was 27.9±5.56 weeks. DIPSI criterion identified 196 women (13.4%) as GDM and the rest as NGT. Insulin was required in 19 (9.7%) women with GDM. Macrosomia was observed in 9.9% GDM women with intervention and 9.8% in NGT (P = 1.000).Conclusion:DIPSI criterion is a one step-cost effective and evidence-based procedure to diagnose GDM in any socio-economic setting.

Evaluation of the incidence and outcome of gestational diabetes mellitus using the current international consensus guidelines for diagnosing hyperglycaemia in pregnancy

“…Wendland et al compared the IADPSG and WHO criteria using 75g OGTT. [20][21][22][23][24][25] They concluded that both the criteria identified women at a small increased risk for adverse pregnancy outcome. Associations were of similar …”

Screening of gestational diabetes mellitus in antenatal women using DIPSI guidelines

“…One of the compelling arguments for a non fasting test has been that most pregnant women will not come back for an OGTT in the fasting state. 19 The WINGS study however showed that 78.5% of women did report for the second OGTT done in the fasting state, even though no incentives were provided to the women.…”

Gestational diabetes mellitus: In search of better screening and diagnostic pathway for Sri Lankan women

“…DIPSI and some of the experts in Sri Lanka have recommended non-fasting GCT to diagnose GDM based on studies carried out in India (12,13,18). However, in these studies GCT was not compared with standard GTT and the cut-off value was justified on the basis of equal prevalence of macrosomia in GDM group and non GDM group.…”

“…While a 75g glucose tolerance test (GTT) is considered as the gold standard test to diagnose GDM, fasting glucose challenge test (GCT) with different cutoff values is also widely used throughout the world. Diabetes in Pregnancy Study Group India (DIPSI) has recommended non-fasting 75g GCT with diagnostic criterion of 2h PG 7.8 mmol/L based on several studies conducted in India (11,12). Nirogi Lanka diabetes prevention task force in Sri Lanka and Sri Lankan College of Obstetricians & Gynecologists (SCOG) too has recommended non fasting GCT with the same cutoff value to diagnose GDM in Sri Lanka (13).…”