PREVALENCE OF GESTATIONAL DIABETES MELLITUS IN AN URBAN INDIAN COHORT USING DIABETES IN PREGNANCY STUDY GROUP IN INDIA (DIPSI) CRITERIA – VALIDATING ONE-STEP APPROACH

  • S. Khan INHS KALYANI, VISAKHAPATNAM, INDIA
  • H. Bal D. Y. PATIL MEDICAL COLLEGE, PUNE, INDIA
  • I. D. Khan ARMY COLLEGE OF MEDICAL SCIENCES AND BASE HOSPITAL, NEW DELHI INDIA http://orcid.org/0000-0002-9824-8711
  • D. Paul ARMY COLLEGE OF MEDICAL SCIENCES AND BASE HOSPITAL, NEW DELHI INDIA
Keywords: gestational diabetes mellitus, DIPSI criteria, screening, pregnancy, glucose tolerance test

Abstract

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 Biographies

S. Khan, INHS KALYANI, VISAKHAPATNAM, INDIA

Classified Specialist Obstetrics and Gynaecology, INHS Kalyani, Visakhapatnam 530014, India

H. Bal, D. Y. PATIL MEDICAL COLLEGE, PUNE, INDIA

Professor Obstetrics and Gynaecology, DY Patil Medical College, Pune, India

I. D. Khan, ARMY COLLEGE OF MEDICAL SCIENCES AND BASE HOSPITAL, NEW DELHI INDIA

Associate Professor, Clinical Microbiology and Infectious Diseases, Army College of Medical Sciences and Base Hospital, New Delhi 110010, India

D. Paul, ARMY COLLEGE OF MEDICAL SCIENCES AND BASE HOSPITAL, NEW DELHI INDIA

Assistant Professor Anaesthesiology, Armed Forces Medical College, Pune 411040, India

References

Metzger BE, Coustan DR. Summary and recom­mendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus: The Organizing Committee. Diabetes Care. 1998;21:B161 7.

Dirar AM, Doupis J. Gestational diabetes from A to Z. World journal of diabetes. 2017 Dec 15;8(12):489. doi:10.4239/wjd.v8.i12.489.

Varma K, Surwade VM, Sinha V, Kachhawa P. Prevalence of Gestational Diabetes And Risk Factors Among Women Visiting Antenatal Clinic of A Tertiary Health Care Hospital. IOSR Journal of Dental and Medical Sciences. 2017; 16(9):1-4.

Rosenblatt B. Prevalence, Health Behaviors, and Preventive Health Practices among Adult Coloradans with Diagnosed diabetes: Results from the Behavioral Risk Factor Surveillance System, 1997–2000. Denver, Colorado Department of Public Health. 2002.

Moon JH, Kwak SH, Jang HC. Prevention of type 2 diabetes mellitus in women with previous gestational diabetes mellitus. The Korean Journal of Internal Medicine. 2017;32(1):26-41. doi:10.3904/kjim.2016.203.

Khan S, Bal H, Khan ID, Paul D. Evaluation of diabetes in pregnancy study group of India (DIPSI) criteria and Carpenter-Coustan criteria for diagnosis of gestational diabetes mellitus. Turkish J Obs Gyn. 2018; 15:75-79. 10.4274/tjod.57255.

Thomas A, Xiang A, Siri LK, Watanabe R. What is Gestational diabetes? Diabetes Care 2007 July; 30 (2): S105-111.

Seshiah V, Balaji V, Balaji MS. Scope for Prevention of Diabetes – Focus intrauterine milieu Interieur. Journal of Association of Physicians of India. 2008 Feb; 56: 109-113.

Luoto R, Kinnunen TI, Aittasalo M, Kolu P, Raitanen J, Ojala K, Mansikkamäki K, Lamberg S, Vasankari T, Komulainen T, Tulokas S. Primary prevention of gestational diabetes mellitus and large-for-gestational-age newborns by lifestyle counseling: a cluster-randomized controlled trial. PLoS medicine. 2011 May 17;8(5):e1001036.

Jovanovic L, Pettit DJ. Gestational diabetes mellitus. JAMA. 2001 Nov 28; 286(20): 2516-8.

Flegal KM. The obesity epidemic in children and adults: current evidence and research issues. Med Sci Sports Exerc 1999;31(Suppl. 11):S509–14.

Cousins L, Baxi L, Chez R, Coustan D, Gabbe S, Harris J, Landon M, Sacks D, Singh S. Screening recommendations for gestational diabetes mellitus. American journal of obstetrics and gynecology. 1991 Sep 1;165(3):493-6.

Van Zyl H, NS Levitt. Pregnancy outcome in patients with pregestational and gestational dia­betes attending Groote Schuur Hospital, Cape Town, South Africa. S Afr Med J. 2018 Aug 28;108(9):772-6. doi: 10.7196/SAMJ.2018.v108i9.12992.

Wahabi H, Fayed A, Esmaeil S, Heba M, Kotb R. Prevalence and complications of pregestational and gestational diabetes in Saudi women: analysis from Riyadh Mother and Baby Cohort Study (RAHMA). BioMed Research International. 2017. https://doi.org/10.1155/2017/6878263.

Baptiste-Roberts K, Barone BB, Gary TL, Golden SH, Wilson LM, Bass EB, Nicholson WK. Risk factors for type 2 diabetes among women with ges­tational diabetes: a systematic review. The American journal of medicine. 2009 Mar 1;122(3):207-14.

Seshiah V, Balaji V, Balaji MS, Panneerselvam A, Kapur A. Pregnancy and diabetes scenario around the world: India. Int J Gynaecol Obstet 2009 Mar; 104 suppl 1: S35-8.

Divakar H, Tyagi S, Hosmani P, Manyonda IT. Diagnostic criteria influence prevalence rates for gestational diabetes: implications for interventions in an Indian pregnant population. Perinatology: Journal of Perinatal & Neonatal Care. 2008 Nov 1;10(6).

Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Kapur A. Pregnancy and diabetes scenario around the world: India. International Journal of Gynecology & Obstetrics. 2009 Mar 1;104(Supplement). S35-8.

Yu ZB, Han SP, Guo XR. Intelligence in relation to obesity: a systematic review and meta-analysis. Obes Rev. 2010 Sep; 11(9): 656-7.

Kale SD, Yajnik CS, Kulkarni SR, Meenakuma­ri K, Joglekar AA, Khorsand N, Ladkat RS, Ramdas LV, Lubree HG. High risk of diabetes and metabolic syndrome in Indian women with gestational diabetes mellitus. Diabetic medicine. 2004 Nov;21(11):1257-8.

Gandhewar MR, Bhatiyani BR, Singh P, Gaikwad PR. A study of the prevalence of gestational diabetes mellitus and its maternal and fetal out­comes in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2017 Sep;6(9):4011-4015. DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174054

Zargar AH, Sheikh MI, Bashir MI, Masoodi SR, Laway BA, Wani AI, Bhat MH, Dar FA. Prevalence of gestational diabetes mellitus in Kashmiri women from the Indian subcontinent. Diabetes research and clinical practice. 2004 Nov 1;66(2):139-45.

Wahi P, Dogra V, Jandial K, Bhagat R, Gupta R, Gupta S, Wakhloo A, Singh J. Prevalence of gestational diabetes mellitus (GDM) and its outcomes in Jammu region. J Assoc Physicians India. 2011 Apr;59(4):227­-30.

Choudhary N, Rasheed M, Aggarwal V. Prevalence of gestational diabetes mellitus, maternal and neonatal outcomes in a peripheral hospital in North India. Int J Res Med Sci. 2017 Jun;5(6):2343-2345. DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20172034

Reddy KM, Lakshmi SP, Balmuri S, Jagarla­mudi A, Betha K. Prevalence of gestational diabetes mellitus and perinatal outcome: a rural tertiary teaching hospital-based study. Int J Reprod Cont­racept Obstet Gynecol. 2017 Aug;6(8):3594-3598. DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20173491.

Tripathi R, Verma D, Gupta VK, Tyagi S, Kalaivani M, Ramji S, Mala YM. Evaluation of 75 g glucose load in non-fasting state [Diabetes in Pregnancy Study group of India (DIPSI) criteria] as a diagnostic test for gestational diabetes mellitus. The Indian journal of medical research. 2017 Feb;145(2):209014. Doi: 10.4103/ijmr.IJMR_1716_15.

Forsbach G, Vázquez-Lara J, Alvarez-y-Gar­cía C, Vázquez-Rosales J. Diabetes and pregnancy in Mexico. Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion. 1998;50(3):227-31.

Lao TT, Ho LF, Chan BC, Leung WC. Maternal age and prevalence of gestational diabetes mellitus. Diabetes Care. 2006; 29(4): 948-9.

Khan ID, Gupta N, Rangan NM, Singh R, Sharma AK, Khurana A, Rudra P, Krushnarao MS. Evaluation of pre and post analytical variables in clinical microbiology services in multidisciplinary ICU of a medical college and tertiary care hospital. Journal of Basic and Clinical Medicine. 2016 Apr 5;5(1).2-4.

Khan ID, Khan SA, Asima B, Hussaini SB, Zakiuddin M, Faisal FA. Morbidity and Mortality amongst Indian Hajj pilgrims: A 3-year experience of Indian Hajj Medical Mission in Mass-Gathering Medicine. Journal of Infection and Public Health. 2017 Jun 28. Pii: S1876-0341(17)30147-8. http://dx.doi.org/10.1016/j.jiph.2017.06.004

Gifford F. Uncertainty about clinical equipoise. Clinical equipoise and the uncertainty principles both require further scrutiny. BMJ 2001; 322:795.

Khan S, Khan ID. The Pregnant Indian pilgrim at Hajj and associated obstetric and neonatal outcomes: A 3-year experience of Indian Hajj Medical Mission. Sultan Qaboos Univ Med Journal. Epub Ahead of print. 2018, eISSN 2075-0528, ISSN 2075-051X. DOI: 10.18295/squmj

Vij P, Jha S, Gupta SK, Aneja A, Mathur R, Waghdhare S, Panda M. Comparison of DIPSI and IADPSG criteria for diagnosis of GDM: a study in a north Indian tertiary care center. International Journal of Diabetes in Developing Countries. 2015 Sep 1;35(3):285-8.

Published
2019-03-01
How to Cite
Khan, S., Bal, H., Khan, I., & Paul, D. (2019). PREVALENCE OF GESTATIONAL DIABETES MELLITUS IN AN URBAN INDIAN COHORT USING DIABETES IN PREGNANCY STUDY GROUP IN INDIA (DIPSI) CRITERIA – VALIDATING ONE-STEP APPROACH. International Journal of Medicine and Medical Research, 4(2), 13-19. https://doi.org/10.11603/ijmmr.2413-6077.2018.2.9317