Abstract
Gestational diabetes mellitus (GDM) is one of the most common metabolic complications of pregnancy. Ever since the first systematic evaluation of the oral glucose tolerance test by O’Sullivan and colleagues was carried out in 1964, there has been controversy with respect to the optimal screening and diagnostic criteria to detect GDM. The recently proposed International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for GDM has found fairly widespread acceptance, but it is still debated by several societies. This review intends to provide an overview of the evolution of the screening and diagnostic criteria for GDM. Debatable issues regarding optimal screening strategies, especially in the low resource settings of low and middle income countries are highlighted. The recent Women in India with GDM Strategy (WINGS) project carried out in Chennai, India tried to develop a Model of Care for GDM suitable for resource constrained settings. The findings related to screening and diagnosis of GDM based on WINGS are also highlighted in this review. Based on the WINGS experience we believe that despite the constraints in low and middle income countries at the present time, the IADPSG criteria appears to be the best. This will also help to bring out a uniform criteria for screening and diagnosis of GDM worldwide.
Highlights
The criteria for diagnosing diabetes outside of pregnancy, has evolved over time and have been largely accepted by major diabetes organizations worldwide
The analysis showed that the incremental cost effectiveness ratios (ICER) in risk factor selected population using National Institute for Health and Care Excellence (NICE) 2015 criteria was in the range of £20,000 to £30,000 per quality adjusted life year (QALY), as compared to an ICER of £47,000 in the subset without risk factors
The results showed that the capillary blood glucose (CBG) had a low sensitivity when compared with venous plasma glucose (VPG)
Summary
The criteria for diagnosing diabetes outside of pregnancy, has evolved over time and have been largely accepted by major diabetes organizations worldwide. The screening and diagnosis of gestational diabetes mellitus (GDM) continues to be a contentious issue. Notwithstanding decades of research and several international workshops devoted to GDM, there is still no consensus among international bodies on a uniform global approach to screening and diagnosis of GDM [1]. Guidelines for GDM screening and diagnosis vary among countries and between major societies worldwide. Even within a country, there is lack of consensus between the diabetes. The lack of consensus regarding the screening and diagnostic criteria for GDM means that different sets of women would be identified as having GDM by the different criteria. Poor dissemination of information and availability of resources could be some of the reasons for these conflicting guidelines used in different settings
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