Review of FIGO & ADA, WHO, IADPSG Guidelines for GDM for Low Resource Setting and Integration of DIPSI with MOHFW Govt of India, Guidelines

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) Indian Guidelines (DIPSI Test) are simple and can be done easily in low resource setting where large number of pregnant women visit for ANC check-up. The severity of GDM increases because of the action of insulin is diminished (insulin resistance) due to raised hormone secretion by the placenta. Other risk factors for GDM are being 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 hyperglycaemia are at higher risk of developing GDM in subsequent pregnancies and 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 endorsed by the FIGO guideline on 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 of health care facilities. Around 28,000 ANM have been given glucometers, strips, glucose 75 gm packets for implementation of the largest GDM program in Uttar Pradesh, India to date.