Early Gestational Diabetes Mellitus Screening and Treatment

Submitted: 14 June 2024; Accepted: 25 June Dec 2024; Published: 27 June 2024

Editorial Rajesh Jain¹

Corresponding Author, ¹Rajesh Jain MD, PG Diploma Diabetes (UK), Consultant Jain Hospital & Research Centre, 108 B Gandhi gram, Kanpur-208007, India. Email:[email protected]

Universal DIPSI Guidelines and Early Gestational Diabetes Screening: The Following Points need our attention to prevent Diabetes from in-utero to adults

1. 1. Two types of GDM: one with high insulin resistance and one with low insulin resistance. The DIPSI Guidelines capture pregnant women with high insulin resistance, reflected in the Single Test Procedure Postprandial Blood Glucose ≥140 mg/dl[1]. In contrast, the IADPSG Guidelines fasting component captures pregnant women with low insulin resistance, and Post Prandial 153 mg/dl with high insulin resistance (but if Post Prandial threshold is lowered to 140 as in DIPSI) will be able to capture missing high insulin resistance. The IADPSG Guidelines recommend that GDM be diagnosed if any one value is abnormal in OGTT, but the diagnosis can only be made if OR=1.5 is implemented rather than 1.75 [2].
   2. In one study from Italy that used DIPSI and IADPSG criteria in the same Pregnant women, both guidelines have almost the same prevalence but contain different types of Patients[3].
   3. The IADPSG Guidelines used in China need revision. If the postprandial criteria 140 mg/dl were used in these guidelines, it would also support the diagnosis of non-GDM high Insulin resistance, as the Asian genotype has high Postprandial insulin resistance compared to Caucasians.
   4. The TOBOGM study discovered that early Medical Nutrition Therapy (MNT) can decrease Gestational Diabetes Mellitus (GDM) complications associated with primary neonatal outcomes. The study, named Towards Better Outcomes in Gestational Diabetes Mellitus (TOBOGM), underscores the crucial importance of early screening at the start of pregnancy, followed by personalized interventions for identified GDM cases. The study revealed a 24.9% adverse neonatal outcome rate in the immediate treatment group and a 30.5% rate in the control group. However, after adjustment, the risk difference was insignificant [4]. 
   5. In a recent study by Seshiah et al.[5] in Chennai, the intervention group, consisting of 69 pregnant women with blood glucose levels of ≥110 mg/dl, had an adverse neonatal outcome rate of 30.4%. In contrast, the non-intervention group, comprising 82 pregnant women with blood glucose levels of ≤110 mg/dl (control group), had a lower rate of 12.2%. The difference was statistically significant at p .006.

Reference:

1. 1. Seshiah V, Balaji V, Bronson SC, Jain R, Chandrasekar A. Diagnosing Gestational Diabetes by a Single-Test Procedure Is a Propitious Step Towards Containing the Epidemic of Diabetes. Cureus. 2021 Nov 25;13(11):e19910. Doi: 10.7759/cureus.19910
   2. Seshiah V, Shah SS, Balaji V, Anjalakshi C, Jain R. When are we Going to Settle the Diagnostic Criteria of Gestational Diabetes Mellitus? J Assoc Physicians India. 2019 Oct;67(10):70-72. https://pubmed.ncbi.nlm.nih.gov/31571457
   3. Corrado F, Di Benedetto A, Di Vieste G, La Fauci L, Martinelli C, D’Anna R, Pintaudi B. Diagnosing Gestational Diabetes with a Probably Too Simplified Diagnostic Procedure Compared to International Criteria: The Indian Case Study. J Clin Med. 2022 Jun 28;11(13):3745. doi: 10.3390/jcm11133745)
   4. Simmons D, Immanuel J, Hague WM, Teede H, et al. TOBOGM Research Group. Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy. N Engl J Med. 2023 Jun 8;388(23):2132-2144. doi: 10.1056/NEJMoa2214956
   5. Seshiah, Veeraswamy; Lakshmi, Geetha; chandrasekar, Anjalakshi; Jain, Rajesh; Selvam, Panneer  (2024), “Primordial Prevention of Gestational Diabetes Mellitus A Novel Approach”, Mendeley Data, V2, doi: 10.17632/m6wg96kxfw.2

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How do you cite this article,  Rajesh Jain. Early Gestational Diabetes Mellitus Screening and Treatment Diabetes Asia Journal.2024;1(1):1-2. https://doi.org/10.62996/daj.01072024