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

Authors

  • Rajiv Kumar Saxena Department of Obstetrics and Gynecology, MVJ Medical College and Research Centre, Bangalore, Karnataka, India
  • Noor Fathima Tameem Ansari Department of Obstetrics and Gynecology, MVJ Medical College and Research Centre, Bangalore, Karnataka, India
  • Pallavi Singh Department of Obstetrics and Gynecology, MVJ Medical College and Research Centre, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20200344

Keywords:

Diabetes in pregnancy study group in India, Gestational diabetes mellitus, International association of diabetes and pregnancy study groups, Oral glucose tolerance test, Pregnancy

Abstract

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.

References

Alfadhli EM. Gestational diabetes mellitus. Saudi Med J. 2015;36(4):399-406.

Kampmann U, Madsen LR, Skajaa GO, Iversen DS, Moeller N, Ovesen P. Gestational diabetes: a clinical update. World J Diabetes. 2015;6(8):1065-72.

Lee KW, Ching SM, Ramachandran V, Yee A, Hoo FK, Chia YC, et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Preg Childbirth. 2018;18(1):494.

Rani PR, Begum J. Screening and diagnosis of gestational diabetes mellitus, where do we stand. J Clin Diagn Res. 2016;10(4):QE01-QE4.

Chi C, Loy SL, Chan SY, Choong C, Cai S, Soh SE, et al. Impact of adopting the 2013 World Health Organization criteria for diagnosis of gestational diabetes in a multi-ethnic Asian cohort: a prospective study. BMC Pregnancy Childbirth. 2018;18(1):69.

Balaji V, Balaji M, Anjalakshi C, Cynthia A, Arthi T, Seshiah V. Diagnosis of gestational diabetes mellitus in Asian-Indian women. Indian J Endocrinol Metab. 2011;15(3):187-90.

Li KT, Naik S, Alexander M, Mathad JS. Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis. Acta Diabetol. 2018;55(6):613-25.

Brown FM, Wyckoff J. Application of one-step IADPSG versus two-step diagnostic criteria for gestational diabetes in the real world: impact on health services, clinical care, and outcomes. Curr Diab Rep. 2017;17(10):85.

Agarwal MM, Dhatt GS, Punnose J, Koster G. Gestational diabetes: dilemma caused by multiple international diagnostic criteria. Diabet Med. 2005;22(12):1731-6.

Ferrara A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care. 2007;30 Suppl 2:S141-6.

Kuo CH, Chen SC, Fang CT, Nien FJ, Wu ET, Lin SY, et al. Screening gestational diabetes mellitus: The role of maternal age. PLoS One. 2017;12(3):15.

Mishra S, Bhadoria AS, Kishore S, Kumar R. Gestational diabetes mellitus 2018 guidelines: An update. J Family Med Prim Care. 2018;7(6):1169-72.

Srinivasan S, Reddi RP. Comparative study of DIPSI and IADPSG criteria for diagnosis of GDM. Int J Reprod Contracept Obstet Gynecol. 20148;7(3):933.

Mohan V, Mahalakshmi MM, Bhavadharini B, Maheswari K, Kalaiyarasi G, Anjana RM, et al. Comparison of screening for gestational diabetes mellitus by oral glucose tolerance tests done in the non-fasting (random) and fasting states. Acta Diabetol. 2014;51(6):1007-13.

Tripathi R, Verma D, Gupta VK, Tyagi S, Kalaivani M, Ramji S, et al. 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. Indian J Med Res. 2017;145(2):209.

Herath M, Weerarathna TP, Umesha D. Is non fasting glucose challenge test sensitive enough to diagnose gestational diabetes mellitus? Int Arch Med. 2015;8:93.

Seshiah V. National Guidelines to Diagnose GDM. J Clin Diabetol. 2015;2:2.

Suresh Babu G, Babu Rao R, Shwetha K, Imran AS, Ratna Kumari V. Comparing the glucose values by glucometer and laboratory methods in the diagnosis of gestational diabetes mellitus: A hospital-based study. Int J Cur Med Apl Sci. 2015;7(1):21-9.

Jadhav DS, Wankhede UN. Comparative study of capillary blood glucose estimation by glucometer and venous plasma glucose estimation in women undergoing the one step DIPSI test (diabetes in pregnancy study group India) for screening and diagnosis of gestational diabetes mellitus. Int J Reprod Contracept Obstet Gynecol. 2017;6:1488-92.

Downloads

Published

2020-01-28

Issue

Section

Original Research Articles