Economical and Evidence Based "A Single Test Procedure" for Diagnosing GDM is Likely to be Globally Relevant

Abstract

OGTT is performed in pregnant women by measuring the plasma glucose in fasting or non-fasting after 2-hour ingesting 75 grams of Glucose (Monohydrate Dextrose Anhydrous). For diagnosing gestational diabetes (GDM), the Indian Guidelines (DIPSI Test) are simple. They can be done quickly in low-resource settings where many pregnant women visit for ANC check-ups. The severity of GDM increases because the action of Insulin is diminished (insulin resistance) due to raised hormone secretion by the placenta. Other risk factors for GDM are elderly, increased BMI or obesity, weight gain in pregnancy, history of diabetes in family, stillbirth, or a congenital abnormality in previous deliveries. GDM has previously been considered to be transient during pregnancy and resolve after pregnancy, but pregnant women with hyperglycemia are at higher risk of developing GDM in subsequent pregnancies. About half of the women with a history of GDM will develop type II diabetes within five to ten years after delivery. DIPSI simple testing protocol is endorsed by the National Health Mission (GOI) Guideline on GDM and also supported by the FIGO guideline on the HIP for use in South Asia. This testing protocol has been followed by Sri Lanka, Pakistan, and Bangladesh in the region. Tamil-Nadu state and Uttar Pradesh states in India launched a Universal GDM Program in 2007 and 2016, respectively, covering all pregnancies by testing and managing GDM with MNT, Metformin, and Insulin in most health care facilities. Around 28,000 ANM have been given glucometers, strips, and glucose 75 gm packets to implement the most extensive GDM program in Uttar Pradesh, India.