Indian Express
24 May 2011
By Anuradha Mascarenhas
Pune, India

OBSTETRICIANS and gynaecologists are pitching for a one–step test to detect signs of diabetes in pregnant women and as a possible step towards preventing the disease in their babies.

The standard test involves cumbersome steps for screening and diagnosis, the cause for many dropouts, while the onestep, DIPSI test not only limits visits to the clinic to one rather than two but also involves fewer blood samplings. Those pitching for the DIPSI test cite another drawback in the two–step method – it follows glycemic cutoffs that take into account the risk of the woman developing diabetes in future but not the risk for the foetus.

The Indian College of Obstetricians and Gynaecologists (ICOG) is calling pregnant women to undergo the DIPSI test.

Named for the Diabetes in Pregnancy Study Group, India, the DIPSI test was developed by Dr V Seshiah and group, said Bangalorebased ICOG secretary Dr Hema Divakar. It was validated and published in the Indian guidelines for gestational diabetes mellitus (GDM).

"We are preparing a draft to recommend this single–step test that can be used in low–resource settings and help control diabetes," said Dr Sanjay Gupte, Pune–based convener of the GDM Guidelines Committee of India, who recently discussed the option at a meeting with the Federation of Obstetricians and Gynaecologists Society of India’s technical advisory group.

GDM is defined as glucose intolerance with recognition or onset during pregnancy, irrespective of treatment with diet or insulin. One–third of women with GDM will develop Ty pe II diabetes after pregnancy and their children are at higher risk for obesity and diabetes at a young age The prevalence of GDM is 3.8 per cent in Western countries but up to 15–17 per cent in India, which is genetically more prone to diabetes, with major cities showing 10–15 per cent, said Divakar. If a pregnant woman is de tected with GDM, then proper management can help prevent the disease in the woman and possibly the offspring, said Gupte.

The test is widely used in Tamil Nadu and the ICOG has urged the government to replicate it across states. Diwakar estimates about 15 per cent of practitioners nationwide are offering the tests based only on risk factors and history, which would lead to missing a number of GDM cases.

Dr C S Yajnik, a researcher on foetal programming, told The Indian Express that the spread of the diabetes pandemic to the young means there is now a growing epidemic of GDM. Though usually diagnosed during pregnancy, many women have risk factors dating back before pregnancy, sometimes traceable to early life; many continue to be diabetic after delivery or develop diabetes soon after.

A mild change in the intra–uterine environment influences the baby's prospects not only in the perinatal period but over the entire length of its life, Yajnik said, adding that studies raise a concern that the current practice of diagnosing gestational hyperglycemia in late pregnancy might be bolting the door after the horse has fled. In our attempts to improve perinatal outcomes, we should not ignore the long–term outcomes that have a bearing on the diabetes pandemic, Yajnik said.