IDF21-0355 Puzzle and Muddle in the Guidelines for Diagnosing Gestational Diabetes Mellitus-Efforts to Solve

Abstract

Background: The countries and associations introduced several guidelines to diagnose gestational diabetes mellitus (GDM). After many years, the International Association of Diabetes in Pregnancy Study Group (IADPSG) is the latest guideline. This study group suggests that anyone value of OGTT with 75 g glucose may be diagnosed as GDM based on Odds Ratio (OR) 1.75, but it does not happen on the ground. Center-to-center differences occur in GDM frequency and relative diagnostic importance of fasting, 1-hour and 2-hour glucose levels, which may impact different strategies for diagnosing GDM. In the IADPSG consensus panel, a few countries suggested OR 1.5 for diagnosing GDM. The outcome of a study found the prevalence of GDM was almost the same by following OR 1.5 whether it is in the fasting, 1 hour or 2 hours, which is the idea of suggesting anyone value to diagnose GDM. Aim: The outcome of a study found the prevalence of GDM was almost the same by following OR 1.5 whether it is in the fasting, 1 hour or 2 hours, which is the idea of suggesting anyone value to diagnose GDM. Method: Where is the problem, and What is the problem for not universally accepting IADPSG guidelines? We analyzed our data of n = 1463 antenatal women who underwent OGTT with 75g oral glucose. In this cohort, the cumulative prevalence of GDM was 14.60% based on the IADPSG methodology. Table 1:Tabled 1StepsWorking methodologyNo of GDMSTEP 1FPG > 92 mg/dl is 136 (9.30%)9.30%STEP 2Detect 136 form 1463 and the balance is 1327. Out of 1327 1hr PG > 180 mg/dl is 36 (2.46%).2.46%STEP 3Detect 36 from 1327 and the balance is 1291. Out of 1291 2hr PG > 153 mg/dl is 42 (2.87%).2.87%Total cumulative prevalence14.60% Open table in a new tab Results: Table 2:Tabled 1S.noWorking methodology N =1463No of antenatal womenPercentage1Only FPG ≥ 92 mg/dl1369.30%2Only 1hr PG ≥ 180 mg/dl654.40%3Only 2hr PG ≥ 153 mg/dl986.70%Total cumulative prevalence29920.40% Open table in a new tab The methodology of working out the prevalence of GDM by applying OR 1.5, which few countries suggested during consensus meeting at Pasadena, USA: Table 3. If IADPSG had accepted OR 1.5, the prevalence would be the same for FPG, 1 hr, and 2 hr.Tabled 1S.noWorking methodology n =1463No of antenatal womenPercentage1Only FPG ≥ 90 mg/dl18312.50%2Only 1hr PG ≥ 160 mg/dl19012.90%3Only 2hr PG ≥ 140 mg/dl19613.40% Open table in a new tab Discussion: All the diagnostic criteria require women to be in fasting, but most of the time, pregnant women do not come in the fasting state because of commutation. Many health services, especially in low-resource settings, cannot routinely perform an OGTT in pregnant women. The guidelines and diagnostic criteria which are feasible and straightforward on the ground are essential. as the procedure of following OR 1.5 is cost-effective and suitable for the population belonging to any economic status.