About 25% of practitioners would miss a number of cases of GDM if they are offering the tests only based on risk factors and previous history.

Compared to the west where the prevalence is aprox 3.8% , the figures in INDIA indicate around 15 %. Hence , Indian ethnic population is considered to be AT RISK and UNIVERSAL SCREENING has to be offered in the antenatal period.

TEST ALL ANTENATAL PATIENTS

It is wise to offer the Single step DIPSI test in every trimester. 17 % of cases are picked up before 16 wks of gestation indicating the significance of early testing and intiating early control for a better outcome.

Even if the first trimester tests report normal, the test should be repeated between 24 to 28 weeks of gestation, since the maximum incidence of flare up and developement of GDM occurs in this phase of pregnancy.

It is unwise to delay the testing beyond 28weeks, since late detection reflects a lost opportunity for control.

For screening, the recommended test is a two step test - 50 gm glucose irrespective of the time of last meal, and a one hour venous sample for glucose estimate. If the reading is more than 140mg% , it is declared as screen +ve and the woman is subjected to 100 gm Oral Glucose Tolerence Test (OGTT) with fasting, one hour,two hour and three hour samples.

The OGTT can also be performed by using 75 gm glucose instead of 100gm ( WHO)

to avoid multiple visits and multiple pricks and analysis of multiple samples, a simple ONE STEP TEST called the DIPSI test is established by Dr Seshiah and group in INDIA and has been validated and published and included in INDIAN GUIDELINES for GDM (2009)

This is a single step test both for screening and diagnosis . Irrespective of the last meal, 75 gm glucose is given and a two hour venous sample is drawn for glucose estimates. If values are > 140 mg% , patient is labeled as GDM. and the values between 120 and 140

Multicentric studies in INDIA have shown an incidence of 15 to 17 %

The practice of not offering the screening test universally and not doing the right kind of tests for diagnosis, may be missing many GDM cases in many centers . Only 10 % of practitioners seem to indicate a prevalence of 10-15 %

More clinicians using a ONE STEP TEST may reap more number of cases across the country

If a one Step test is done, it needs to be followed up by FBS and PLBS

if Two step test is followed, OGTT would confirm the diagnosis

either of the methods can be followed

but the cut offs are different and criteria for diagnosis are different

In Indian ethnic population which is at high risk, it is advised to follow Carpenter and Coustan criteria in a OGTT interpretation - this is a stricter criteria demanding lower values for cutoffs .

Using NDDG criteria would miss 27% of GDM who would have otherwise be picked up from the same set antenatal patients if C & C were applied( published 2008 Divakar H & Manyonda IT)

66% of clinicians opine that more than one value has to be abnormal .

But even if one value is abnormal, we label her as gestational glucose intolerence and maintain a strict follow up for a better outcome.

This group should not  be ignored

choice between repeating tests every trimester or everymonth needs to be individualised

either way, one needs to keep track !

5 % of clinicians are using oral hypoglycaemics - not yet in the recommendations for glycaemic control

73 % would refer to the specialist - if such option is available and a multi speciality approach would bring in the best control

Home monitoring is ideal when patient is on insulin.

The inputs for this study is from ObGyns all over the Country and represents the knowledge, attitudes and practices on GDM - both in private and public institutions