Gestational Diabetes In India Research Articles

Veeraswamy Seshiah: Father of Gestational Diabetes in India

Professor Dr. V. Seshiah, MD, FRCP, DSc, (Hony), is a distinguished professor at Tamil Nadu's Dr. MGR Medical University and established the First Department of Diabetology in India at Madras Medical College in 1978. He was the patron of the Research Society for the Study of Diabetes in India and the founder patron of the Diabetes in Pregnancy Study Group, India (DIPSI). Additionally, he served as the Vice-Chair of the Executive Board of the International Association of Diabetes and Pregnancy Study Group. Dr. V Balaji and Dr. V Seshiah Diabetes Care Center & Research Institute, which he founded, received the Army Decorations "SAMAR SEVA STAR" and "SAINYA SEVA MEDAL" in 1965 with clasp HIMALAYAS. Dr. Seshiah was also the recipient of the DR. B.C.ROY National Award was given in 1988 for developing diabetology as the Indian College of Physicians provided a specialty in the country and the Master Teacher Award. Moreover, he was honored with the Lifetime Achievement Award by the International Diabetes Federation in 2017, being the first Indian to receive this award. In 2022, the President of India, Mr. Kovind, presented the Padma Shri to Dr. Veeraswamy Seshiah for Medicine.

Diabetic retinopathy in pregnancy - A review.

Diabetes and gestational diabetes (GD) are areas of concern worldwide. GD can eventually lead to serious development of diabetic retinopathy (DR) during pregnancy or worsening of an already existing DR. GD confers future risk of diabetes, both in the mother and fetus, further complicating their lives. DR in pregnant women has been intriguing in terms of understanding the prevalence, assessing risk factors causing pathogenesis, and problems associated with treating them. Pregnancy itself is a risk factor for progression of DR. Physiological changes such as metabolic, vascular, immunologic, and hormonal changes that occur during pregnancy can cause development as well as worsening of DR. This can eventually lead to permanent visual loss if not addressed on time. Timing of laser, choice of treatment for diabetic macular edema with laser, intravitreal anti-vascular endothelial growth factor agents (VEGF), and intravitreal steroids pose a serious challenge in managing these patients without causing damage to the mother and fetus. This review article showcases the prevalence, risk factors, and pathogenesis, outlines the management of DR in pregnancy, and recommends guidelines based on the available evidence. PubMed and MEDLINE searches were performed pertaining to the prevalence of GD in India, DR in pregnancy, risk factors for progression of DR, role of vasoactive mediators in DR, role of angiopoietic factors in DR, hormonal influence of DR, role of growth factors in DR, use of fluorescein and indocyanine green angiography, retinal lasers, anti-VEGF agents, intravitreal steroids, anesthesia, and retinal surgery, all pertaining to pregnancy and guidelines and recommendations for managing DR in pregnancy.

Educational films for improving screening and self-management of gestational diabetes in India and Uganda (GUIDES): study protocol for a cluster-randomised controlled trial

BackgroundThe prevalence of gestational diabetes mellitus (GDM) is rising rapidly in many low- and middle-income countries (LMICs). Most women with GDM in LMICs are undiagnosed and/or inadequately managed due to a lack of knowledge and skills about GDM on the part of both providers and patients. Following contextual analysis, we developed an educational/behavioural intervention for GDM delivered through a package of culturally tailored films. This trial aims to evaluate whether the intervention can improve the timely detection and management of GDM in two LMIC settings.MethodsTwo independent cluster randomised controlled trials, one each to be conducted in Uganda and India. Thirty maternity facilities in each country have been recruited to the study and randomised in a 1:1 ratio to the intervention and control arms. The intervention comprises of three interconnected sets of films with the following aims: to improve knowledge of GDM guidelines and skills of health providers, to raise awareness of GDM screening among pregnant women and their families, and to improve confidence and skills in self-management among those diagnosed with GDM. In facilities randomised to the intervention arm, a GDM awareness-raising film will be shown in antenatal care waiting rooms, and four films for pregnant women with GDM will be shown in group settings and made available for viewing on mobile devices. Short films for doctors and nurses will be presented at professional development meetings. Data will be collected on approximately 10,000 pregnant women receiving care at participating facilities, with follow-up at 32 weeks gestational age and 6 weeks postnatally. Women who self-report a GDM diagnosis will be invited for a clinic visit at 34 weeks. Primary outcomes are (a) the proportion of women who report a GDM diagnosis by 32 weeks of pregnancy and (b) glycaemic control (fasting glucose and HbA1C) in women with GDM at ~34 weeks of pregnancy. The secondary outcome is a composite measure of GDM-related adverse perinatal-neonatal outcome.DiscussionScreening and management of GDM are suboptimal in most LMICs. We hypothesise that a scalable film-based intervention has the potential to improve the timely detection and management of GDM in varied LMIC settings.Trial registrationClinicalTrials.gov NCT03937050, registered on 3 May 2019. Clinical Trials Registry India CTRI/2020/02/023605, registered on 26 February 2020.

Prevalence of Gestational Diabetes in India by Individual Socioeconomic, Demographic, and Clinical Factors

Gestational diabetes is common in pregnancy and is associated with adverse pregnancy and fetal outcomes. Currently, population-based data on the prevalence of gestational diabetes are limited in India. To provide a comprehensive national assessment of gestational diabetes in India and its socioeconomic, demographic, and geographic associations, using elevated random blood glucose data as a proxy for a gestational diabetes diagnosis. This cross-sectional study analyzed the fourth National Family Health Survey, conducted in India between January 2015 and December 2016. This nationally representative sample comprised 699 686 women 15 to 49 years of age, of whom 32 428 (4.6%) were pregnant. Data were analyzed between July and December 2019 and between July and August 2020. Age, body mass index, hypertension, wealth, and social caste were factors potentially associated with gestational diabetes. Gestational diabetes, defined as elevated random blood glucose according to predetermined thresholds (≥200 mg/dL for nonfasting, ≥92 mg/dL for fasting). Of the 31 746 pregnant women with complete data in the study, the mean (SD) age was 24.3 (4.7) years, and the mean (SD) gestational age was 5.1 (2.3) months. The weighted age-adjusted prevalence of gestational diabetes was 1.3% (95% CI, 1.1%-1.5%). The prevalence of gestational diabetes increased with age, from 1.0% (95% CI, 0.5%-1.5%) at age 15 to 19 years to 2.4% (95% CI, 1.0%-3.8%) at age 35 years or older. The age-adjusted prevalence of gestational diabetes was higher among women with a body mass index of 27.5 or greater (1.8%; 95% CI, 1.0%-2.5%) compared with women with a body mass index of less than 18.5 (0.8%; 95% CI, 0.5%-1.1%), among women in the highest wealth quartile (1.7%; 95% CI, 1.1%-2.5%) compared with those in the lowest (0.9%; 95% CI, 0.7%-1.2%), and women in the south (eg, Kerala: 4.5%; 95% CI, 2.4%-6.7%; Telangana: 5.4%; 95% CI, 0.0%-11.0%) compared with the northeast (eg, Assam: 0.23%; 95% CI, 0.0%-0.48%; Mizoram: 0.16%; 95% CI, 0.0%-0.49%). In this study, considerable variation was found in the prevalence of gestational diabetes by state, socioeconomic status, and demographic factors. This finding has implications for the method of gestational diabetes screening in low-resource settings in India, especially in areas or among demographic groups with lower prevalence.

Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis.

Although diabetes is rapidly increasing in India, there is no national consensus on best practices for screening, diagnosis, and management of gestational diabetes mellitus (GDM). The goal of this study was to systematically review the literature for studies reporting the prevalence and screening and diagnostic methods for gestational diabetes in India. We searched MEDLINE, Embase, and POPLINE for studies on screening for GDM in India. We included English-language full reports and conference abstracts of cross-sectional studies, prospective, and retrospective cohorts that reported the screening method and prevalence of GDM. We performed descriptive analysis on all studies and meta-analysis, meta-regression, and subgroup meta-analysis on studies with medium or low risk of bias. We included 64 studies reporting 90 prevalence estimates. Prevalence estimates ranged from 0 to 41.9%. Subset meta-analyses showed that the IADPSG diagnostic criteria found significantly more GDM cases (prevalence = 19.19% [15.5, 23.6], p < 0.05) than the WHO 1999 criteria (10.13% [8.17, 12.50]) and DIPSI criteria (7.37% [5.2, 10.16]). Studies that compared the IADPSG and WHO 1999 criteria showed poor positive agreement (33-79%). Studies specifying time of GDM diagnosis showed that patients (11-60%) develop GDM as early as the first trimester, but many GDM cases (16-40%) are missed if screened only at first visit. In India, prevalence estimates of GDM vary substantially by diagnostic criteria. When evaluating screening and diagnostic criteria for GDM, providers should consider their patients' needs and correlate screening criteria with pregnancy outcomes.

Gestational diabetes in India: Science and society.

Gestational diabetes in India: Science and society.

Diagnostic effectiveness of 75 g oral glucose tolerance test for gestational diabetes in India based on the International Association of the Diabetes and Pregnancy Study Groups guidelines.

To determine the diagnostic effectiveness of the fasting and one-hour plasma glucose levels for gestational diabetes (GDM) based on International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. A Cross-sectional study that included 2348 pregnant women booked for antenatal care in 2011 at a tertiary care perinatal institute. Pregnant women underwent a 75 g oral glucose tolerance test (OGTT) between 24 and 28 weeks of gestation. Outcome measures include the incidence of GDM based on the IADPSG criteria and the diagnostic effectiveness of the recommended fasting and one-hour plasma glucose cut-off if used in isolation. The incidence of GDM was 21.81% (n = 520, 95% CI: 20.15, 23.57) with the IADPSG criteria. A fasting plasma glucose cut-off 92 mg/dL, in isolation, correctly classified 87.16% of GDM, with a specificity of 96.08%, clinically significant positive likelihood ratio (14.08) and a post-test probability of 79.71%. The one-hour 75 g test, in isolation, correctly classified 85.74% of GDM, had specificity of 99.68% and clinically significant positive likelihood ratio (111.12) and post-test probability of 96.87%. The application of the World Health Organization criteria would misclassify 11.91% (95% CI: 10.66, 13.26) of GDM as normal. Additional testing of plasma glucose levels can be avoided for 18.25% (n = 435, 95% CI: 16.73, 19.84) if the IADPSG diagnostic criteria for GDM are applied with exit on a positive fasting or one-hour test result.

Battling the rising prevalence of gestational diabetes in India: Are clinicians on the right track?

Background: Gestational diabetes (GDM) is associated with increased long term problems of type 2 diabetes in the mother. In the offspring, GDM can append an intrauterine environmental risk factor to the increased genetic risk for the development of childhood obesity and/or type two early adult onset diabetes. Given the high prevalence of GDM in India, there is a real threat of an epidemic of type 2 diabetes in INDIA. Objective: (a) To assess knowledge among obstetricians in India, regarding management of GDM with respect to strict glycemic monitoring to provide the right environment to the fetus and timely intervention. (b) To assess the attitudes and practices with respect to long term follow up of the mother. Materials and methods: A 25-question online survey (www.abcofobg.com) was developed to assess providers' knowledge, practices and attitudes related to the management of GDM. The final sample consisted of 584 respondents. Data were analyzed using SPSS version 16.0. Results: When patients were on insulin, 41% of the clinicians did not insist on daily home monitoring using a glucometer.They resorted to estimation of post breakfast blood glucose at two-week intervals. Only 60% had access to endocrinologists for advice regarding insulin dosage adjustments. Only 35.71% of the clinicians said to wait for spontaneous labor. 64.29% of doctors said they would intervene and deliver at 38 weeks. Out of 584 respondents, 70.24% were aware of long term complication of childhood obesity and adult onset diabetes. Majority of doctors (92.86%) knew that T2DM was the long-term complication in GDM mother and 67.86% were aware of possibility of GDM in next pregnancy. Only 17% of clinicians offered WHO 75 gm testing for sugar estimation at the six weeks postpartum visit and 70% of the practitioners advised regarding exercises and diet. Conclusions: This study raises the challenge of how to translate the evidence from well-resourced research studies into initiatives that are affordable and feasible, whether in richer or poorer parts of the world. Also, the study results reveal the urgent need to improve the quality of diabetes treatment and care: accessible, community-based, multi-disciplinary teams, and patient-centered approach.