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590 Prevention of Non-Communicable Diseases - Whom to Focus?

>Based on the Hyperglycemia and Adverse Pregnan- load*, irrespective of her fasting/ nonfasting status
cy Outcome (HAPO) study, International Association and without regard to the time from the last meal. A
of the Diabetes and Pregnancy Study Groups (IAD- venous blood sample is to be collected at 2 hours for
PSG) has suggested the guidelines . Predominantly estimating plasma glucose by the GOD-POD method.
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HAPO study was performed in Caucasian population GDM is diagnosed if 2-hour PG is ≥ 140 mg/dL(7.8
and population from India, China, South Asian coun- mmol/L). In case 75 g glucose packet is not available,
tries (except city of Bangkok, Hong Kong), Middle remove and discard five level teaspoons (not heaped)
East and Sub Saharan countries were not included. of glucose from a 100 g packet which is freely avail-
The IADPSG recommendations include; that diagno- able. In hospitals where glucose is supplied in bulk, a
sis of GDM is made when any of the following plas- cup or container of 75 g may be used. The marketed
ma glucose values meet or exceed: Fasting: 92 mg/ glucose is available in anhydrous form.
dL, (≥ 5.1 mmol/L), 1-hour: 180 mg/dL ( ≥ 10.0 mmol/L) As glucose concentrations are affected little by the
, 2-hour: 153 mg/dL (≥ 8.5 mmol/L) with 75 g OGTT. time since the last meal in a normal glucose tolerant
The IADPSG also suggests: Fasting plasma glucose woman, it makes it a rationale to perform this test in
(FPG); 126 mg/dL(> 7.0 mmol/L) and A1C > 6.5% in the nonfasting state. After a meal, a normal glucose
the early weeks of pregnancy is diagnostic of overt tolerant woman would be able to maintain euglyce-
diabetes. Fasting >92mg/dL and <126 mg/dL is di- mia due to brisk insulin response against glucose
agnosed as GDM.
challenge. Whereas, a woman with GDM would not
be able to do so due to impaired insulin secretion
Disadvantages of the IADPSG that leads to increase in her glycemic levels with
Recommendations are: glucose challenge and the glycemic excursion may
Most of the time pregnant women do not come in exaggerate further. There are several advantages of
the fasting state because of belief that they should the DIPSI procedure such as: Pregnant women need
not fast for long hours. The dropout rate is very high not be fasting, it causes least disturbance in routine
if they are asked to come back for repeat test for activities of a pregnant woman, and it serves as both
glucose tolerance. In many situations attending the screening and diagnostic procedure. This single-step
first prenatal visit in the fasting state is almost im- procedure has been approved by Ministry of Health,
practical. • The hall mark of GDM is that In all cases Government of India. It is also recommended by
FPG values do not reflect the 2-hour post glucose WHO, Federation of Gynecologist and Obstetrician
with 75 g oral glucose [2-hour plasma glucose (PG)]. and Ministry of Health Government of India.
Two hour PG values are much higher in ethnically The chances of detecting unrecognized type 2 diabe-
Asian Indians compared to Caucasians as they have tes before pregnancy (pre-GDM) is likely to be missed
high insulin resistance. The insulin resistance during if usual recommendation for screening between 24
pregnancy is further increased,hence FPG is not an weeks and 28 weeks of gestation is followed. In case
appropriate option to diagnose GDM in Asian Indian where 2-hour PG is > 200 mg/dL in the early weeks
women. About 76% of pregnant women would have of pregnancy, she may be a pre-GDM and in this case
missed the diagnosis of GDM made by WHO criterion A1C of ≥ 6.5 becomes confirmatory. A pregnant wom-
by following FPG > 5.1 mmol/L as cut-off value, in an found to have normal glucose tolerance (NGT), in
this population.
the first trimester, should be tested again for GDM
Diabetes in Pregnancy Study Group India (DIPSI), around 24th–28th week and finally around 32nd–34th
has recommended single step procedure for diag- week.
nosing GDM in community . DIPSI diagnostic criteria
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of 2-hour PG ≥ 140 mg/dL is similar to WHO criteria Conclusion
2-hour PG ≥ 140 mg/dL. This was developed due to FEMALE GENDER: THE KEY TO DIABETES PREVEN-
the practical difficulty in performing glucose toler- TION and thus Maternal health is the link to the NCD
ance test in the fasting state, challenge of women epidemic. GDM is the mother of non communicable
revisiting the antenatal clinic and that too in fasting disease. Hence preventive measures against Type 2
state. Hence, it was important to have a test that de- DM should start right from intrauterine period and
tects the glucose intolerance at first visit itself, irre- continue throughout life from early childhood.GDM
spective of fasting or fed state. offers an important opportunity for the development,
Procedure In the antenatal clinic should include ,after testing and implementation of clinical strategies for
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completing preliminary clinical examination of preg- diabetes prevention and NCD . Public Health Priority
nant women, she should be given 75 g oral glucose is to initiate the action in screening all pregnant wom-

GCDC 2017