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

Conclusion:- (Balaji V, MadhuriBalaji, Anjalakshi C, Cynthia A,
Arthi T, Seshiah V. (2011). Diagnosis of gestational
2 hr PG ≥ 140 mg/dl with 75g oral glucose diabetes mellitus in Asian-Indian women.Indian J En-
administered in pregnant women in the fasting or docrinolMetab. July 2011, Vol 15, Issue 3, pp. 187-190)
non fasting state, without regard to the time of the
last meal is able to identify women with GDM. WHO Observations and Recommendations

Rationale 2013
(a) For a pregnant woman, the request to attend fast-
Performing this single test procedure in the
fasting or non-fasting state irrespective of the last ing for a blood test may not be realistic because of
meal timing is rational as glucose concentrations the long travel distance to the clinic in many parts of
during the Glucose Tolerance Test will be affected the world, and increased tendency to nausea in the
least by the time since the last meal in Normal Glu- fasting state. Consequently nonfasting testing may
cose Tolerant women but will in GDM. be the only practical option.
(b)There was no statistically significant difference in
(Catalano PM et al. Carbohydrate metabolism during
pregnancy in control subjects and women with GDM. the glycaemic response between non-fasting and
Am J Physiol 264: E60-67, 1993 ) standard OGTT in diagnosing GDM.
(Anjalakshi C, Seshiah V, Balaji V, Madhuri S Balaji, c) A 2-step procedure requiring attendance on 2 sep-
Ashalatha S, Sheela Suganthi, Arthi T, Thamizharasi arate occasions is often not feasible in many low and
M, A single test procedure to diagnose gestational middle income countries. Not recommended
diabetes mellitus. ActaDiabetologica 46 (1) : 51-54, (Strategies for Implementing the WHO Diagnostic
March 2009.) Criteria and Classification of Hyperglycaemia First
Detected in Pregnancy. Stephen Colagiuri, Maicon-
* This “walk in test” is recommended by Diabetes In
Pregnancy Study Group India.(DIPSI). Falavigna, Mukesh M. Agarwal, Michel Boulvain,
Edward Coetzee, Moshe Hod, Sara Meltzer, Boyd
(Balaji v, Balajimadhuri, Anjalakshi C, Cynthia A, Arthi Metzger, Yasue Omori, Ingvars Rasa, Maria Inês,
T, Seshiah V, Diagnosis of gestational diabetes melli- Veerasamy Seshiah, David Simmons, Eugene Sob-
tus in Asian-Indian Women. Indian Jounal of Endocri- ngwi, Maria Regina Torloni, Hui-xia Yang. DRCP. 103
nology and Metabolism, year 2011, Volume :15, Issue (2014) 364-372 )
:3, page no:187-190.)
A “Single Step Procedure” to diagnose GDM is also
* Diagnosis of GDM with 2-h PG ≥ 140 mg/dl and recommended by WHO -2013
treatment is worthwhile with a decreased macroso-
mia rate, fewer emergency cesarean sections, seri- (Ref - WHO/NMH/MND/13.2)
ous perinatal morbidity and may also improve the
women’s health-related quality life. Disadvantage of two-step procedure
This two-step procedure is cumbersome & also the
(Crowther CA, Hiller JE, Moss JR, et al. Effect of treat- phenomenon of “No show” occurs as the woman
ment of gestational diabetes mellitus. N Engl J Med has to visit the antenatal clinic or laboratory in a
2005; Vol. 352, No. 24, 2477-86.)
fasting state.
(Gayle C, Germain S, Marsh MS, et al. Comparing 20-29% of screen positive women did not return for
pregnancy outcomes for intensive versus routine an- the diagnostic test.
tenatal treatment of GDM based on a 75 gm OGTT
2- h blood glucose (>140 mg/dl). Diabetologia.2010; (Luiz Guilherme Kraemer de Aguiar ,Haroldo Jose de
Vol. 53, Suppl. No. 1, S435.) Matos, Marilia de Brito Gomes. Diabetes Care 2001:
24: 954-5. )
(Jitendra Singh et al .Prevalence of Gestational Diabe-
tes Mellitus (GDM) and Its Outcomes in Jammu. JAPI (V Seshiah, V Balaji, Madhuri S Balaji, CB Sanjeevi,
(59): April 2011. ) A Green GestationalDiabetes Mellitus in India. JAPI
52, 2004. 707-11)
(V Seshiah, V Balaji, Madhuri S Balaji, ArunaSekar,
C B Sanjeevi, Anders Green: One step procedure for Indian subcontinent: medium to low resource set-
screening and diagnosis of gestational diabetes mel- tings serving ethnic populations at high risk
litus. J ObstetGynecol India 2005. Vol. 55,No.6: No- 2 hour value after 75g OGTT in fasting or non fasting
vember/December: 525-529
state.Value > 140 is GDM

GCDC 2017