With India being touted as the Diabetic Capital of the World, and the incidence of type 2 diabetes increasing pregnancy provides us with an unique opportunity to screen this group of population. If discovered to be having GDM , proper counselling and management can go a long way in preventing diabetes in the woman and possibly the offspring. This would have an immense public health impact since GDM incidences as high as of 15- 20 % are quoted from various regions in India.
This rising incidence calls for a change in attitude of the practitioner to GDM and also a need to screen the population stringently and cost effectively. In a diverse health care delivery system like ours (public health system, private system having private practitioners & corporate setups); with different resources available (or not available) - there is a need to evolve a sensitive and simple screening protocol which can be followed. To do this a study of the existing practices is essential.

From the data received till now the following observations have emerged -

Screening:
Most of the responders were offering universal screening and to their patients. Those ( 20%) doing selective screening may be missing out on 35% of women with GDM. The test applied for screening varied. 50GCT as screening test was most frequently done ( 40%) with fasting and PP / and WHO 75GCT being the next popular ( 23- 25%). A small percentage relied only on urine sugar. Glycosuria is unreliable since 73% of patients with glycosuria turn out not to have GDM; and a large majority of GDM will not have glycosuria!

Incidence:
64 % report as the incidence being less that 10% in their practice- Maybe a more sensitive test for screening needs to be applied here. Only 25 % report the incidence as 15 to 20% or more in their practice.

Diagnosis and Management:
Once the screen is positive majority do a definite test either 100 OGTT or 75 gm WHO test. But approx 25 % do a F & PLBS to confirm GDM. This is possibly since OGTT 3 hour test is a cumbersome test , but the WHO test is fairly straight forward and can be employed here . For diagnosis of diabetes technically ( in non pregnant patients) one requires 2 abnormal readings to diagnose diabetes but with gestational diabetes it is important even to follow up one abnormal reading because these patients also at times present with complications of GDM. Majority of doctors realise this and followed up the patients subsequently . Once diagnosed it was interesting to note that 15 % put them on insulin themselves and 4 % would even consider starting oral hypoglycemics. Though there is no recommendation till now for use of oral Hypoglycemics they do hold promise. Around 45% of the doctors relay on frequent PLBS for monitoring their patients on Insulin- with 35% offering home monitoring by glucometer.

Obstetric Management:
56% said that they would wait for spontaneous labour in their well controlled patients , while 43 % would interfere at 38 weeks. Most of them would induce their cases with only 23% resorting to an elective LSCS.
In poorly controlled patients 30% would interfere at 34 weeks-( too early ); 38.5 each at 36 and 37 weeks 19.3 at 38 weeks. Let us not forget that lung maturity with abnormal sugars is delayed so it may be prudent to wait till 38 weeks if fetal and maternal health allows.
Post Partum Most of the respondents relied on PLBS to monitor their patients 6 weeks postpartum.
Most recognize the long term consequences of GDM on mother and baby.