scholarly journals Effectiveness of diabetes in pregnancy study group India diagnostic criterion in detecting gestational diabetes mellitus: a rural Bangalore study

Author(s):  
Rajiv Kumar Saxena ◽  
Noor Fathima Tameem Ansari ◽  
Pallavi Singh

Background: The oral glucose tolerance test (OGTT) is considered the current standard for diagnosis of gestational diabetes mellitus (GDM). International association of diabetes and pregnancy study groups (IADPSG) recommends OGTT, with fasting, one-hour and two-hour venous blood samples drawn after intake of 75g oral glucose. In the Indian context, diabetes in pregnancy study group in India (DIPSI) recommends glucose challenge test (GCT), where 75 g glucose is given irrespective of the fasting state, and a single venous sample is drawn after two-hour. Diagnosis of GDM is made, if any cut-off value is met or exceeded. This prospective study was conducted to compare the DIPSI and IADPSG criteria for diagnosis of GDM.Methods: Pregnant women between 24 to 28 weeks of gestation were subjected to non-fasting GCT. Capillary sample were also drawn simultaneously using Accu check active glucometer. These women were counselled to undergo a standard 75gram OGTT, within a week of recruitment.Results: According to IADPSG criteria, 17.6% (18/102) of our participants had GDM, as compared to 19.6% (20/102) by DIPSI criteria using venous samples, and 25.3% (25/99) by capillary sample method. Sensitivity and specificity of GCT using venous sample was 72.22% and 91.67%, and using capillary sample was 70.59% and 84.15% respectively. DIPSI criteria using venous samples wrongly labelled 8.3% women as GDM, and capillary samples wrongly labelled 15.9% women as GDM. More importantly DIPSI criteria using venous samples labelled 27.8% women as false-negative and capillary samples labelled 29.4% women as false-negative for GDM. Almost one quarter of women with GDM will be missed if DIPSI criteria is used as a universal screening modality.Conclusions: We suggest that the IADPSG criteria be used for diagnosis of GDM in antenatal women in India.

2021 ◽  
Vol 11 (6) ◽  
pp. 1-5
Author(s):  
Aradhana Singh ◽  
Raj K Singh ◽  
Vani Aditya

Introduction: In view of the alarmingly increasing incidence of Gestational Diabetes Mellitus (GDM), worldwide, as well as in India, a consensus to bring about standardization for diagnosis of GDM is needed. Internationally, the WHO 2013 criteria is being widely used, while (Diabetes In Pregnancy Study Group of India) DIPSI non fasting criteria is popularly used in India. There still remains many missed cases of GDM in India, which is a cause of concern. This study was done to compare the DIPSI non fasting, with WHO 2013 criteria for diagnosis of GDM. Methods: this cross-sectional study included 530 pregnant women, attending antenatal clinic of a tertiary care center, of North India, from Feb. 2018 to March 2019 and fulfilling inclusion criteria. All women attending antenatal clinic, during the study period, were subjected to capillary glucose evaluation, 2 hours after 75g oral glucose load, irrespective of the timing of last meal (DIPSI), as part of routine antenatal checkup. After 7 days, only those 530 women, who turned up in fasting state, and fulfilled inclusion criteria, were enrolled in the study and subjected to fasting 75g, oral glucose tolerance test (OGTT) (WHO 2013). Accuracy of DIPSI test was compared, to the fasting WHO 2013 criteria. Capillary glucose was measured using regular, well calibrated, point of care, “Optium Free Style” glucometer. Results: Out of 107 women diagnosed to have GDM by WHO 2013 criteria, only 89 were diagnosed by the DIPSI criteria. DIPSI had a low sensitivity (83.18%) when compared to the WHO 2013 criteria, Conclusion: This study showed that when non fasting DIPSI criteria was used as diagnostic criteria, 10.58% women with GDM, missed the diagnosis. Considering the adverse maternal and perinatal outcome of GDM, implication of missed diagnosis would be grave, especially in a developing country, like India. Hence, use of DIPSI criteria for diagnosing GDM should be reconsidered. Key words: GDM, DIPSI, OGTT, Diabetes in Pregnancy.


Author(s):  
S. Khan ◽  
H. Bal ◽  
I. D. Khan ◽  
D. Paul

Background. India is the “World’s Diabetes capital”, with half the diabetic population being women. Early detection of glucose intolerance during pregnancy offers a timely opportunity for screening, management and prevention of gestational diabetes mellitus (GDM) and prevents fetal complications. Objective. The study assessed the prevalence of GDM in an Indian cohort using the Diabetes in Pregnancy Study group of India (DIPSI) criteria. Methods. 200 pregnant women underwent two-phase testing with non-fasting 75-gram glucose challenge under Diabetes in Pregnancy Study group of India (DIPSI) criteria at <20 weeks and between 24-28 weeks period of gestation. A 3-hour 100-gm oral glucose tolerance test (OGTT) was used for confirmation. Repeat testing was done for women negative during the first-phase. Results. Mean age was 24.26±3.75 years with 52.5% multigravidas. Mean Body Mass Index (BMI) was 20.7±3.07 kg/m2. The prevalence of GDM in study cohort was found to be 15.5% using the DIPSI criteria while the prevalence of GDM after 100 g OGTT was 13.0%. GDM was mostly seen to occur in women of 26-30-year age group. Statistically significant associations for age and GDM, and BMI and GDM were evidenced. Conclusions. Maternal age of ≥25 years should be adopted as a risk factor for the development of GDM. The DIPSI criteria offer a cost-effective and an evidence-based protocol for a single-step definitive glucose test for both screening and diagnosis of pregnant patients belonging to any socio-economic strata; furthering its implementation for public health obstetrics.


Author(s):  
Shashikala H. Gowda ◽  
Tarigopula Swathi ◽  
Rakshitha B.

Background: Diabetes is one of the most common non communicable diseases globally. India is considered as the world diabetes capital. Women detected with gestational diabetes mellitus (GDM) have an increased incidence of developing diabetes; especially type 2 diabetes mellitus in the later life, and future development of obesity and diabetes in the offspring. So the aim of this study is to validate the sensitivity and specificity of diabetes in pregnancy study group of India (DIPSI) recommended 75 g oral glucose challenge test (OGCT) by comparing with carpenter and couston 100 g oral glucose tolerance test (OGTT) and to note the prevalence of gestational diabetes in antenatal population attending Kempegowda Institute of Medical Sciences (KIMS).Methods: All antenatal patients reporting to our hospital at or before 24 to 28 weeks period of gestation will be recruited for the study. Patients at random will be subjected to 75g glucose load according to DIPSI criteria and one week later to carpenter and couston 100 g OGTT. Blood glucose is estimated from venous blood using glucose oxidase and peroxidase (GOD-POD) method and patients diagnosed according to respective criteria.Results: Most of the patients were in age distribution of 20–25 years. Among 100 patients in study group 28 were diagnosed as GDM by DIPSI criteria. Among 100 patients, 12 patients were detected as GDM by carpenter and couston GTT, 19 patients had impaired glucose tolerance. The incidence of GDM in the antenatal population attending KIMS hospital between gestational ages of 24–28 weeks is 12%.Conclusions: DIPSI can be used as a diagnostic test for GDM as one step simple and easy procedure especially I low resource settings like India for improved pregnancy outcome.


Author(s):  
Trupti C. Ruge ◽  
Nisha Kanchana

Background: Considering the magnitude of adverse pregnancy outcomes related to gestational diabetes, the present study was undertaken to find out the prevalence of gestational diabetes mellitus using the international association of diabetes in pregnancy study groups criteria (IADPSG) and diabetes in pregnancy study group India (DIPSI) criteria to ascertain whether the present practice of diagnosing GDM by the guidelines recommended by DIPSI 21 based on WHO criterion of 2-h PG ≥140 mg/dL can still be followed in this study settings or adopt IADPSG recommendation.Methods: This study was done at Antenatal Clinic, department of obstetrics and gynecology, KLES Dr Prabhakar Kore Hospital, Belgaum from January 2013 to December 2013. A total of 225 pregnant women between 24 to 28 weeks gestations were studied. Diagnosis and the prevalence of GDM were assessed by applying both DIPSI and IADPSG criteria.Results: Most of the women (58.11%) were between 22 to 25 years and the mean age was 23.78±3.38 years. Based on the IADPSG criteria, the prevalence of GDM was 19.11% and by applying DIPSI criteria, prevalence of GDM was 16.89%. The difference in diagnostic capability between IADPSG and DIPSI was found to be 2.8% and the kappa statistics showed good strength of agreement between the two tests (p>0.302; Kappa=0.774).Conclusions: It was concluded that, the diagnosis GDM based on DIPSI is as effective as IADPSG criteria. Further, in resource poor countries like India, DIPSI procedure would be used with an advantage of being less costly and without compromising the clinical equipoise. 


Author(s):  
Somya Sinha ◽  
Niranjan M. Mayadeo

Background: The optimal strategy for screening and diagnosis of Gestational Diabetes Mellitus (GDM) is still controversial and elusive. There is possibility of difference in maternal and fetal outcome depending on the diagnostic method used. This study throws light on the efficacy of two screening tests “Oral Glucose Tolerance Test’’ and “Diabetes in Pregnancy Study Group India” and to know maternal and fetal outcome in pregnancy complicated by GDM in Indian setting.Methods: Depending on the diagnostic method used 100 GDM patients were divided in 2 groups: 1. OGTT, 2. DIPSI. Maternal outcomes were measured in terms of pregnancy induced hypertension, polyhydramnios, preterm labour, genital tract injury and methods of termination of pregnancy, gestational age at delivery. Congenital malformation, macrosomia, hypoglycemia, hyperbilirubinimia, respiratory distress, duration of NICU stay was studied in newborns.Results: 22% of DIPSI group and 26% of OGTT group had PIH as comorbidity. Preterm delivery was noted in 22% of DIPSI group and 30% of OGTT group. 50% patients of both the groups underwent LSCS. No intrapartum complications were seen in 82% of patients. Malformations were noted in 18% of DIPSI group and 14% of OGTT group. In DIPSI group 14% of baby had macrosomia compared to 10% and in that of OGTT group.In neonates, hypoglycaemia, respiratory distress syndrome and hyperbilirubinemia seen in 46.8%, 31% and 42.6% respectively in DIPSI group compared to 50%, 45.5% and 47.7% respectively in OGTT group.Conclusions: No statistically significant difference was noted with respect to maternal and fetal outcomes between the two groups.


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