EARLY DETECTION AND TREATMENT OF IMPAIRED GLUCOSE AND HYPERINSULINEMIA IN EARLY PREGNANCY TO PREVENT DIABETES AND CARDIOVASCULAR DISEASE IN ADULTS

Abstract

Objective: So far, no attempt has been made the Prevention of Diabetes and CVD in the community. There is a concept that GDM is the mother of Non-Communicable Diseases. Hence, the aim is to decide the glycemia level which predicts the development of GDM. The suggestion is that HbA1C of more than 5.3 (110mg/dl) during the 10th week of pregnancy predicts GDM. HBA1C 5.7 during pregnancy establishes GDM in Asian ethnicity, and HbA1c measured in the first trimester is helpful for early prediction of GDM. A blood test performed at the 10th week of pregnancy and if PPBS >110 mg% may help identify a pregnant woman at risk of GDM. Hence in the 8th week itself, PPBS has to be estimated. If the PPBS is >110 mg%, a grace period of two weeks is available to maintain PPBS<110mg% at the 10th week. Another essential physiology is that at the 11th week, Fetal beta cell insulin secretion starts. If PPBS remains, more than 110 mg% fetal hyperinsulinemia occurs, which is undesirable. Design and method: Testing for PPBS at the 8th week with 110mg/dl so that enough time is available before fetal insulin secretion starts in the 11th week. If PPBS more than 110mg/dl in the 8th week, the PPBS should be controlled with MNT and Exercise and, if necessary, with Metformin so that PPBS should be maintained at less than 110mg/dl (99 +/- 10) till the 12th week. At the 16th week, 75gm OGCT (DIPSI Test) should be done to know whether she develops GDM and, if negative, be repeated at the 24th and 32nd weeks. Points to Remember:PPBS more than 110mg/dl around the 10th week predicts GDM Fetal Beta Cell starts secreting insulin in the 11th week. The maternal PPBS should be less than 110mg/dl till the 12th week. Results: The Pregnant woman is unlikely to develop Gestational Diabetes if 2-hour PPBS around the 10th Week is less than <110 mg/dl with MNT or Metformin Conclusions: Early Pregnancy hyperglycemia at 8th Weeks detection and treatment may prevent future Diabetes and NCDs especially CVD.