Battling with Rising Prevalence of Gestational Diabetes Mellitus: Screening and Diagnosis

Abstract

ABSTRACT Introduction Gestational diabetes affects 2 to 4% of all pregnancies, with an increased risk of developing diabetes for both the mother and the child. The prevalence of gestational diabetes mellitus (GDM) in India varied from 3.8 to 21% with the geographical locations and diagnostic methods used. Objective To study the differences in the type of tests and timing of tests; failure to screen and diagnose; this could explain the varying prevalence reported from different centers indicating that there could be an underestimation due to missed diagnosis. Materials and methods A 15-question online survey (www.abcofobg.com) was developed to assess providers’ knowledge; practices and attitudes related to the screening and management of GDM. All data were entered into an electronic database without personal identifiers, to maintain confidentiality. The data was analyzed by using SPSS version 16.0. Results A total of 584 respondents were participated in the survey. Overall, 82.14% of doctors screened all their antenatal patients for GDM. A total of 65.48% of them ordered for a blood glucose test during first antenatal visit even in first trimester. During screening, 39.29% of doctors preferred 50 gm glucose challenge test and 26.19% of doctors preferred 75 gm glucose and 2-hour reading. When the test was positive, 47.62% of doctors ordered for 100 gm oral glucose tolerance test (OGTT) and 38.1% for 75 gm OGTT. A total of 40.48% of doctors used C and C criteria, 26.4 % used National Diabetes Data Group (NDDG) criteria and 32.14% took 140 at 2 hours for 75 gm OGTT criteria of cutoff to diagnose the GDM. Conclusion Preventive measures against type 2 diabetes (T2DM) should start with proper screening and diagnosis during pregnancy. Many tests with varied criteria are in use. There is an urgent need to institute uniform standards for the timing and type of tests done for identifying the cases of GDM. This is crucial to reduce the burden of T2DM in India for now and for generations to come.