Magon Navneet
Department of Obstetrics and Gynaecology, Air Force Hospital, Kanpur Cantt, India.
Indian J Endocrinol Metab. 2011 Jul;15(3):161-9. doi: 10.4103/2230-8210.83398.
Screening and diagnosis for gestational diabetes mellitus (GDM) as well as interventions for its management evoke considerable controversy. There are different types of screening methods: universal or risk-based, one step or two step. Different thresholds for diagnosis of GDM have been in vogue. Previous definition and diagnostic criteria had no place for diagnosis of overt diabetes in pregnancy. Following Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study and International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations, new screening and diagnostic criteria around the world seem to be gaining consensus. The present recommendation given by IADPSG for screening and diagnosis of diabetes mellitus in pregnancy has two discrete phases. The first is detection of women with overt diabetes not previously diagnosed or treated outside of pregnancy. Universal early testing in populations is recommended at the first prenatal visit. The second phase is a 75-g OGTT at 24-28 week gestation in all women not previously found to have overt diabetes or GDM. ACHOIS and MFMU Network trails have proven benefit in treating hyperglycemias less than what is diagnostic for diabetes. DIPSI has shown the alternative way for resource-challenged communities. Efforts from all stake holders with interest in GDM are required to make the diabetes capital of the world into the diabetes care capital of the world.
妊娠期糖尿病(GDM)的筛查、诊断及其管理干预措施引发了诸多争议。筛查方法有多种类型:普遍筛查或基于风险的筛查、一步法或两步法。GDM的诊断阈值也各不相同。以往的定义和诊断标准并未涵盖妊娠显性糖尿病的诊断。随着高血糖与不良妊娠结局(HAPO)研究以及国际糖尿病与妊娠研究组协会(IADPSG)建议的出台,全球新的筛查和诊断标准似乎正在达成共识。IADPSG目前给出的关于妊娠糖尿病筛查和诊断的建议有两个不同阶段。第一阶段是检测出妊娠前未被诊断或治疗过的显性糖尿病女性。建议在首次产前检查时对人群进行普遍早期检测。第二阶段是对所有此前未被发现患有显性糖尿病或GDM的女性,在妊娠24 - 28周时进行75克口服葡萄糖耐量试验(OGTT)。ACHOIS和MFMU网络试验已证明,治疗低于糖尿病诊断标准的高血糖具有益处。DIPSI为资源匮乏社区提供了另一种途径。需要所有对GDM感兴趣的利益相关者共同努力,将世界糖尿病之都转变为世界糖尿病护理之都。