Diabetes in Pregnancy Study Group in India (DIPSI) – A Novel Criterion to Diagnose GDM

Abstract

Background: Gestational diabetes mellitus (GDM) is defined as glucose intolerance recognised first only during pregnancy. Women with GDM are more prone to future diabetes and other maternal and fetal complications.  Most of the people in India reside in rural areas and an Universal screening is required in such settings which is simple, convenient and economical. Diabetes in Pregnancy Study Group India (DIPSI) has recommended a modified 75 g oral glucose tolerance test (OGTT) to diagnose GDM. Very few studies are available to show the effectiveness of DIPSI. Aim: Our aim is to compare and correlate WHO and DIPSI CRITERIA in diagnosing GDM. Materials and Methods: 149  healthy pregnant women attending antenatal clinic of Santhiram General Hospital  underwent 75 g OGTT between 24-28 weeks of pregnancy recommended by WHO. Two venous blood samples and urine samples, one fasting and other 2 hr sample after 75 g glucose load were obtained and analysed. Three days later all of them were made to undergo 75 g OGTT recommended by DIPSI. A single 2 hr blood sample was collected after the load and analysed. Both criteria values are subjected to statistical analysis. Statistical Analysis: The mean and S.D of age and parity, BMI, 2 hr plasma glucose were calculated. Comparision and correlation of diagnostic criteria of  GDM by WHO and DIPSI were analyzed by Fischer exact test (chi- square test) and significance done  using Statistical analysis using SPSS software (version 20) and MedCalc (version 12.7.0). Results: Out of 149 pregnant women who underwent screening for GDM, 63 were diagnosed to have GDM. The mean age and S.D of nonGDM and GDM pregnant women were 22.7±3.5 vs 24.35±4.77 year. The mean 2nd hr glucose values and S.D of nonGDM and GDM cases were 98±14 vs154.32±8.7mg/dl. WHO identified 63 GDM cases and DIPSI identified 58 GDM cases i.e. 92% of GDM cases identified by WHO were found to be identified by DIPSI. Out of them 52 women were diagnosed as GDM by both WHO and DIPSI. We compared the correlation of DIPSI with WHO 2ndhr sample for diagnosing GDM by Fischer exact t-test. P-value and its significance is calculated. Chi squared test equals to 75.181(P<0.0001) which is extremely significant. Conclusion: DIPSI has all those qualities of a screening test. It is simple, single, convenient, economical, can be used as both diagnostic as well as screening test and with good perinatal outcome. So can be used in routine laboratory to diagnose GDM.