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Gestational Diabetes Guidelines India

Pmnch | Test Pregnant Women And Prevent Future Diabetes

Pmnch | Test Pregnant Women And Prevent Future Diabetes

Test pregnant women and prevent future diabetes Looking for signs of diabetes already in pregnancy may become a tipping point in bending the curve of the diabetes pandemic, which is now reaching pandemic heights with 425 million people affected worldwide "There are many good reasons for testing pregnant women for diabetes, says Rikke Fabienke, Senior Global Access to Care Manager at Novo Nordisk. In the immediate short term women get better maternal outcomes and in the long term, mothers and babies reduce their risk of developing life-long type 2 diabetes." Uncontrolled blood sugar levels during pregnancy can result in diabetes later in life for both mother and child. Luckily, blood sugar can both be measured and controlled in most cases lifestyle changes are enough, in rare cases medication is needed. Substantial evidence shows that controlling pregnant womens blood sugar levels is key to delay or prevent future diabetes in mother and child. While measuring the blood sugar during pregnancy is standard procedure in high-income healthcare systems, it is still not common practice in some of the countries facing the heaviest diabetes burden. This is the case in India home to the second largest diabetes population in the world (1). About 10-14% of all pregnant women in India are estimated to have diabetes in pregnancy (2); however, blood sugar testing is not yet a standard practice in large parts of the country. As a consequence, women go undiagnosed and experience complications during pregnancy and child birth, which often go unaccounted for because no one connects the dots between diabetes and maternal health. This happened to Chaya who at the age of 34 lives with type 2 diabetes and has had three C-sections and one still birth. It was not until her third pregnancy that Continue reading >>

Gestational Diabetes Mellitus--guidelines.

Gestational Diabetes Mellitus--guidelines.

Type: Practice Guideline, Journal Article The Diabetes In Pregnancy Study group India (DIPSI) is reporting practice guidelines for GDM in the Indian environment. Due to high prevalence, screening is essential for all Indian pregnant women. DIPSI recommends that as a pregnant woman walks into the antenatal clinic in the fasting state, she has to be given a 75g oral glucose load and at 2 hrs a venous blood sample is collected for estimating plasma glucose. This one step procedure of challenging women with 75 gm glucose and diagnosing GDM is simple, economical and feasible. Screening is recommended between 24 and 28 weeks of gestation and the diagnostic criteria of ADA are applicable. A team approach is ideal for managing women with GDM. The team would usually comprise an obstetrician, diabetes physician, a diabetes educator, dietitian, midwife and pediatrician. Intensive monitoring, diet and insulin is the corner stone of GDM management. Oral agents or analogues though used are still controversial. Until there is evidence to absolutely prove that ignoring maternal hyperglycemia when the fetal growth patterns appear normal on the ultrasonogram, it is prudent to achieve and maintain normoglycemia in every pregnancy complicated by gestational diabetes. The maternal health and fetal outcome depends upon the care by the committed team of diabetologists, obstetricians and neonatologists. A short term intensive care gives a long term pay off in the primary prevention of obesity, IGT and diabetes in the offspring, as the preventive medicine starts before birth. Continue reading >>

Moh Releases Revised Guidelines For Gestational Diabetes

Moh Releases Revised Guidelines For Gestational Diabetes

MoH releases revised guidelines for gestational diabetes MoH releases revised guidelines for gestational diabetes Undiagnosed or inadequately treated GDM can lead to significant maternal and foetal complications. The Ministry of Health has released revised guidelines strengthening its stand on universal screening of all pregnant women for gestational diabetes mellitus (GDM). According to the report titled Diagnosis and Management of Gestational Diabetes Mellitus released recently, if the first prenatal test was found negative, a second test should be done at 24-28 weeks of gestation. Undiagnosed or inadequately treated GDM can lead to significant maternal and foetal complications. Moreover, women with GDM and their children are at increased risk of developing type 2 diabetes later in life. The new guidelines provide for creating a cadre of healthcare providers for medical nutritional threrapy and inclusion of oral drugs like metformin for control of sugar. According to the guidelines, States are free to choose the number of districts where the programme will be implemented initially, however all districts should be be covered in a phased manner. Continue reading >>

Screening For Gestational Diabetes

Screening For Gestational Diabetes

Chairperson, Medical Disorders in Pregnancy Committee, FOGSI Pregnancy induces progressive changes in maternal carbohydrate metabolism. As pregnancy advances insulin resistance and diabetogenic stress due to placental hormones necessitate compensatory increase in insulin secretion. When this compensation is inadequate gestational diabetes develops. ‘Gestational Diabetes Mellitus’ [GDM] is defined as carbohydrate intolerance with onset or recognition during pregnancy. Women diagnosed to have GDM are at increased risk of future diabetes predominantly type 2 DM as are their children . Thus GDM offers an important opportunity for the development, testing and implementation of clinical strategies for diabetes prevention [ . Timely action taken now in screening all pregnant women for glucose intolerance, achieving euglycemia in them and ensuring adequate nutrition may prevent in all probability, the vicious cycle of transmitting glucose intolerance from one generation to another. Screening & Diagnosis A number of screening procedures and diagnostic criteria (ADA, WHO, CDA, NDDG and Australasian criteria) are being followed in the same as well as in different countries. American Diabetes Association (ADA) recommends screening for selective (high risk) population. But compared to selective screening, universal screening for GDM detects more cases and improves maternal and neonatal prognosis [4,5]. Hence universal screening for GDM is essential, as it is generally accepted that women of Asian origin and especially ethnic Indians, are at a higher risk of developing GDM and subsequent type 2 diabetes. ADA procedure ADA recommends two step procedures. Step 1: A 50 g glucose challenge test (GCT) is used for screening without regard to the time of last meal or time of the day. St Continue reading >>

Diabetes India - Diagnosis

Diabetes India - Diagnosis

It is generally accepted that diabetes is a major health problem all over the world, and especially so in the developing countries. India has the dubious distinction of being home to one in five persons with diabetes worldwide. The World Health Organisation (WHO) predicts that the number of people with diabetes is to double in the next couple of decades and that the major brunt of this will be borne by the developing countries. In fact, diabetes has long passed the stage of being an epidemic in India, but can be said to have reached "pandemic" proportions. But when one talks of numbers of people with diabetes, it presumes that the diagnosis of diabetes is based on criteria and methods which have evolved based on the scientific data which is presently available, and not on abstract assumptions. One must feel confident that the diagnosis is correct, fully established and reproducible. After all, the diagnosis of diabetes is something which will "stick" with a person throughout one's life. As it has been so aptly said,"once a diabetic, always a diabetic!" India has the dubious distinction of having the largest number of people with diabetes. Recent studies have shown that for every person known to have diabetes, there are more than 2 people who have diabetes but are unaware of it. In fact, many persons with Type II diabetes already show the presence of the long term complications associated with diabetes at the time of diagnosis. It is now widely accepted that if diabetes is detect3d early and adequate steps are taken, it may be possible to significantly delay the onset and progression of these complications. Thus, this is all the more reason to try and diagnose the onset of diabetes at the earliest. Although diabetes does have its typical signs and symptoms, many people Continue reading >>

Guidelines - Governnment Of India

Guidelines - Governnment Of India

Technical and Operational Guidelines: Gestational Diabetes Mellitus Guidance Note on Operationalization of Dakshata in New States Revised Operational guidelines for Strengthening of Pre-Service Education for Nursing Midwifery cadre in India Operational Guidelines for Obstetric HDU and ICU LaQshya-Labour Room Quality Improvement Initiative Guidelines for Maternal Death Surveillance & Response Operational Framework- Pradhan Mantri Surakshit Matritva Abhiyan Pradhan Mantri Surakshit Matritva Abhiyan Daksh Skills Lab for RMNCH+A Services - Training Manual for Facilitators Daksh Skills Lab for RMNCH+A Services - Training Manual for Participants DAKSHATA - Empowering Providers for Improved MNH Care during Institutional Deliveries Operational Guideline DAKSHATA - Empowering Providers for Improved MNH Care during Institutional Deliveries - Facilitators Guide Guidance Note on Use of Uterotonics during labour Guidance Note on Prevention and Management of Postpartum Haemorrhage Guidance on Ensuring Access to safe Abortion and Addressing Gender Biased Sex Selection Maternal Near Miss Operational Guidelines National Guidelines for Calcium Supplementation During Pregnancy and Lactation National Guidelines for Diagnosis & Management of Gestational Diabetes Mellitus National Guidelines for Screening of Hypothyroidism during Pregnancy National Guidelines for Deworming in Pregnancy Continue reading >>

Gestational Diabetes Guidelines Revised

Gestational Diabetes Guidelines Revised

The Ministry of Health has released revised guidelines strengthening its stand on universal screening of all pregnant women for gestational diabetes mellitus (GDM). According to the report titled Diagnosis and Management of Gestational Diabetes Mellitus released last week, if the first prenatal test was found negative, a second test should be done at 24-28 weeks of gestation. Worldwide, one in 10 pregnancies is associated with diabetes, 90% of which are GDM. Undiagnosed or inadequately treated GDM can lead to significant maternal and foetal complications. Moreover, women with GDM and their children are at increased risk of developing type 2 diabetes later in life. Hema Divakar, Federation of Obstetric and Gynaecological Societies of India (FOGSI) ambassador to International Federation of Gynaecology and Obstetrics (FIGO), who is one of the contributors to the guidelines, told The Hindu on Thursday that the focus was on making the original guidelines released in 2014 implementable and feasible in the Indian context. Pointing out that the original guidelines were implemented with great difficulty in Hoshangabad of Madhya Pradesh on a pilot basis, she said there were several logistical issues and the health workers found it difficult to test all pregnant women. But every time they came across a hurdle, it was resolved to ensure it is implemented, she said. Based on Hoshangabad experience, we felt there is an urgent need to prevent and minimise maternal and foetal morbidity associated with GDM. The revised guidelines strengthen the provision of universal screening and management of GDM as part of the essential antenatal package, she said. The report also underlines post-delivery testing. Apart from this, the new guidelines provide for creating a cadre of healthcare provide Continue reading >>

Gestational Diabetes Mellitus - Indian Guidelines

Gestational Diabetes Mellitus - Indian Guidelines

Seshiah V, Sahay BK, Das AK, Siddharth Shah, Samar Banerjee, Rao PV, Ammini A, Balaji V, Sunil Gupta, Hema Divakar, Sujata Misra, Uday Associated medical fraternity: Diabetes In Pregnancy Study Group India [DIPSI] - V Seshiah (Chennai), A K Das (Puduchery), V Balaj: (Chennai), Madhuri S Balaji (Chennai), Sunil Gupta (Nagpur), A Panneerselvam (Chennai), Anuj Maheshwari (Lucknow), Shyam Mukundan (Alwaye), Mary John (Ludhiana), Lilly Rodrigues (Hyderabad), Association of Physicians of India [API] - Siddharth N Shah (Mumbai), B K Sahay (Hyderabad), Muralidhar Rao (Gulbarga), N Rajendran (Chennai), Indian Medical Association [IMA] - Samar Bannerjee (Kolkata), A Bhavadharini (Erode), Federation of Obstetric & Gynecological Societies of India [FOGSI] C N Purandare (Mumbai), Sanjay Gupte (Pune), Sujata Misra (Cuttack), Hema Divakar ( Bengaluru), Uday Thanawala (Navi Mumbai), Ambarish Bhandiwad (Mysore), Cynthia Alexander (Chennai), Anjalakshi C (Chennai), Research Society for the Study of Diabetes in India [RSSDI] - K M Prasanna Kumar (Bengaluru), P V Rao (Hyderabad), Jitendra Singh (Jammu), Mayur Patel (Ahmedabad) Endocrinology Society of India - Ammini Ariachery (New Delhi), Shashank R Joshi (Mumbai) Diabetes India - Shaukat Sadikot (Mumbai), Indian Society of Neonatology Geetha (Chennai), Epidemiologist - Manjula Datta Pregnancy induces progressive changes in maternal carbohydrate metabolism. As pregnancy advances insulin resistance and diabetogenic stress due to placental hormones necessitate compensatory increase in insulin secretion. When this compensation is inadequate gestational diabetes develops. Gestational Diabetes Mellitus [GDM] is defined as carbohydrate intolerance with onset or recognition during pregnancy. Women diagnosed to have GDM are at increased risk of f Continue reading >>

The Challenges And Recommendations For Gestational Diabetes Mellitus Care In India: A Review

The Challenges And Recommendations For Gestational Diabetes Mellitus Care In India: A Review

Gestational diabetes mellitus (GDM) is a primary concern in India affecting approximately five million women each year. Existing literature indicate that prediabetes and diabetes affect approximately six million births in India alone, of which 90% are due to GDM. Studies reveal that there is no consensus among physicians and health-care providers in India regarding management of GDM prepartum and postpartum despite available guidelines. Also, there is no consensus among physicians as to when a woman should undergo oral glucose tolerance test after delivery. This clearly shows that management of GDM is challenging and controversial in India due to conflicting guidelines and treatment protocols, despite availability of straightforward protocols for screening and management. Also, a collaborative approach remains a key for GDM management, as patient compliance and proper educational interventions promote better pregnancy outcomes. Management of GDM plays a pivotal role, as women with GDM have an increased chance of developing diabetes mellitus 5–10 years after pregnancy. Also, children born in GDM pregnancies face an increased risk for obesity and type 2 diabetes. The cornerstone for the management of GDM is glycemic control and quality nutritional intake. GDM management is complex in India, and existing challenges are multifactorial. However, there are little published data outlining these challenges. This review gives an account of some of the key challenges from self-management and health-care provider perspective. The recommendations in this review provide insights for building a more structured model for GDM care in India. This research has several practical applications. First, it points out to reaching a consensus on approaches for screening, diagnosis, and treatm Continue reading >>

Gestational Diabetes Mellitus: Get, Set, Go From Diabetes Capital Of The World To Diabetes Care Capital Of The World Magon N - Indian J Endocr Metab

Gestational Diabetes Mellitus: Get, Set, Go From Diabetes Capital Of The World To Diabetes Care Capital Of The World Magon N - Indian J Endocr Metab

Gestational diabetes mellitus (GDM) is a topic of considerable controversy. It is so especially when it comes to its screening and diagnosis and at times even to justify interventions for its management and their cost-effectiveness adds to the controversy. It is more controversial whether maternal hyperglycemias less severe than that in diabetes mellitus are associated with increased risks of adverse pregnancy outcomes. A fair trial to demystify the entire spectrum of this disease: what is GDM, its relevance, how and when to screen pregnant women for GDM, diagnostic criteria for GDM, its management, and its effects on mother and baby, shall be made in a series of review articles. Also, equally important is to discuss why GDM requires efforts on the part of clinicians to screen and manage women for it? The present review article shall concentrate on defining GDM, its present day relevance, screening, and diagnostic criteria. India leads the world with largest number of diabetic subjects earning the dubious distinction of "the diabetes capital of the world.0" It was estimated to have had 31.7 million people having diabetes in year 2000 which is projected to be 79.4 million by year 2030. [1] Both the figures are highest in the world. During the next 2 decades, the world population is expected to increase by 37%, but the prevalence of diabetes will increase by 114%. More bothersome is a 151% projected increase in number of people with diabetes vis a vis just a 40% projected increase in population of India during the same period. According to the Diabetes Atlas More Details 2009 published by the International Diabetes Federation, the number of people with diabetes in India in year 2010 was reported to be around 50.8 million which is expected to rise to 69.9 million by 2025 Continue reading >>

Gestational Diabetes Mellitus: A Diagnostic Dilemma

Gestational Diabetes Mellitus: A Diagnostic Dilemma

1 Department of Cardiology, IPGME&R, Kolkata, West Bengal, India 2 Department of Obstetrics and Gynaecology, IPGME&R, Kolkata, West Bengal, India Correspondence Address: Rakesh Agarwal IPGMER and SSKM Hospital, AJC Bose Road, P.S-Bhowanipur, Kolkata - 700 020, West Bengal India Source of Support: None, Conflict of Interest: None DOI: 10.4103/cjhr.cjhr_29_17 Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Despite decades of research and debate, confusion regarding screening and diagnostic criteria for GDM has been persistent. Despite initially been touted as the diagnostic criteria of choice, the Diabetes in Pregnancy Study Group India criteria themselves have been fraught with controversy. We review the disease and its history in brief with a timeline of different criteria proposed for its diagnosis which have only but added to dilemma in its diagnosis. Keywords: Diabetes in Pregnancy Study Group in India, Diagnosis of GDM, Gestation Diabetes Mellitus Pregnancy has been described as a transient excursion into the metabolic syndrome and as a window to women's health. Metabolic adaptations are necessary during pregnancy for the growth and development of the fetus and also to meet the altered demands of the mother. Glucose seems to be the major substrate for the human fetus throughout pregnancy. Hence, glucose metabolism has been the most extensively studied, yet little explored, subject of metabolism in pregnancy. Diabetes mellitus is one of the oldest diseases known to humanity, being described in ancient texts more than 2000 years back. However, definitive medical literature on diabetic pregnancy has been scanty. In the preinsulin era, diabetes was thought to be incompatible with succe Continue reading >>

Screening For Gestational Diabetes In India: Where Do We Stand?

Screening For Gestational Diabetes In India: Where Do We Stand?

Screening for gestational diabetes in India: Where do we stand? Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India Department of Diabetology, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India 1Department of Endocrinology, Associates in Clinical Endocrinology, Education and Research (ACEER), Chennai, Tamil Nadu, India 2Department of Gynecology and Obstetrics, Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India Address for correspondence: Dr. V. Mohan, E-mail: [email protected] Author information Copyright and License information Disclaimer Copyright : 2015 Journal of Postgraduate Medicine This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. This article has been cited by other articles in PMC. Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.[ 1 ] It remains an area of controversy, in areas including selective versus universal screening, timing of testing, choice of one-step or two-step approach, and the criteria to be used to diagnose GDM. Some of these controversies have been plaguing this field for several decades and they continue to remain unresolved. Until recently, many researchers questioned the very need to screen for GDM, and its cost-effectiveness in particular.[ 2 ] Many professional bodies were convinced of the need to screen, but uncertainty existed on how to do this Continue reading >>

Gestational Diabetes

Gestational Diabetes

Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy.[2] Gestational diabetes generally results in few symptoms;[2] however, it does increase the risk of pre-eclampsia, depression, and requiring a Caesarean section.[2] Babies born to mothers with poorly treated gestational diabetes are at increased risk of being too large, having low blood sugar after birth, and jaundice.[2] If untreated, it can also result in a stillbirth.[2] Long term, children are at higher risk of being overweight and developing type 2 diabetes.[2] Gestational diabetes is caused by not enough insulin in the setting of insulin resistance.[2] Risk factors include being overweight, previously having gestational diabetes, a family history of type 2 diabetes, and having polycystic ovarian syndrome.[2] Diagnosis is by blood tests.[2] For those at normal risk screening is recommended between 24 and 28 weeks gestation.[2][3] For those at high risk testing may occur at the first prenatal visit.[2] Prevention is by maintaining a healthy weight and exercising before pregnancy.[2] Gestational diabetes is a treated with a diabetic diet, exercise, and possibly insulin injections.[2] Most women are able to manage their blood sugar with a diet and exercise.[3] Blood sugar testing among those who are affected is often recommended four times a day.[3] Breastfeeding is recommended as soon as possible after birth.[2] Gestational diabetes affects 3–9% of pregnancies, depending on the population studied.[3] It is especially common during the last three months of pregnancy.[2] It affects 1% of those under the age of 20 and 13% of those over the age of 44.[3] A number of ethnic groups including Asians, American Indians, Indigenous Australians, and Pacific Continue reading >>

Trends In The Diagnosis Of Gestational Diabetes Mellitus

Trends In The Diagnosis Of Gestational Diabetes Mellitus

Copyright © 2016 Surabhi Mishra et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable degree with onset or recognition during pregnancy. As prevalence of diabetes is linked to impaired glucose tolerance during antenatal period, routine antenatal screening of GDM is required. However, screening tests for GDM remain controversial. Objective. To review different diagnostic criteria for GDM. Materials and Methods. Freely accessible, full-text articles from 1964 to 2015, available in PubMed in English language, pertaining to screening of GDM were reviewed. Results. First diagnostic criteria for GDM in 1964 by O’Sullivan and Mahan, modified by the National Diabetes Data Group (NDDG) in 1979 and Carpenter in 1982. The cut-off value as per WHO definition of GDM was 140 mg/dL, 2 hours after 75 g glucose intake. Diabetes in Pregnancy Study Group India (DIPSI), in 2006, endorsed WHO criteria but irrespective of the last meal timings. Being cost-effective, it formed the basis of national guidelines for Indians in 2014. Conclusions. As typical clinical scenarios are usually varied, practical guidelines that meet the constraints of low-resource settings like India are required. 1. Introduction Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable degree with onset or recognition during pregnancy. As per the International Diabetes Federation (IDF), Diabetes Atlas 2015, one in seven births are affected by GDM [1]. India, being the second leading dweller of diabetic subjects (69.2 millio Continue reading >>

Japi - Dipsi Guidelines

Japi - Dipsi Guidelines

Abstract The Diabetes In Pregnancy Study group India (DIPSI) is reporting practice guidelines for GDM in the Indianenvironment. Due to high prevalence, screening is essential for all Indian pregnant women. DIPSI recommendsthat as a pregnant woman walks into the antenatal clinic in the fasting state, she has to be given a 75g oralglucose load and at 2 hrs a venous blood sample is collected for estimating plasma glucose. This one stepprocedure of challenging women with 75 gm glucose and diagnosing GDM is simple, economical and feasible.Screening is recommended between 24 and 28 weeks of gestation and the diagnostic criteria of ADA areapplicable. A team approach is ideal for managing women with GDM. The team would usually comprise anobstetrician, diabetes physician, a diabetes educator, dietitian, midwife and pediatrician. Intensive monitoring,diet and insulin is the corner stone of GDM management. Oral agents or analogues though used are stillcontroversial. Until there is evidence to absolutely prove that ignoring maternal hyperglycemia when thefetal growth patterns appear normal on the ultrasonogram, it is prudent to achieve and maintainnormoglycemia in every pregnancy complicated by gestational diabetes. The maternal health and fetal outcomedepends upon the care by the committed team of diabetologists, obstetricians and neonatologists. A shortterm intensive care gives a long term pay off in the primary prevention of obesity, IGT and diabetes in theoffspring, as the preventive medicine starts before birth. © INTRODUCTION The maternal metabolic adaptation is to maintain themean fasting plasma glucose of 74.5 ± 11 mg/dl andthe post prandial peak of 108.7 ± 16.9mg/dl.1 This fine tuning of glycemic level during pregnancy is possibledue to the compensatory hyperinsulinaemi Continue reading >>

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