Seshiah V, Balaji Vijayam, Bronson Stephen C, Jain Rajesh, Chandrasekar Anjalakshi
Diabetology, The Tamil Nadu Dr. M.G. Ramachandran Medical University, Chennai, IND.
Diabetology, Dr. V. Balaji Dr. V. Seshiah Diabetes Care and Research Institute, Chennai, IND.
Cureus. 2021 Nov 25;13(11):e19910. doi: 10.7759/cureus.19910. eCollection 2021 Nov.
In recent years, diabetes has evolved into a non-communicable disease pandemic with data showing that one out of ten adults in the world have diabetes. Among various factors that contribute to this rising trend in diabetes, one factor that is of paramount importance is gestational diabetes mellitus (GDM). Maternal hyperglycemia sets off a vicious cycle that affects not only the mother and her child but also the generations to come. There are many criteria that are used for the diagnosis of GDM. Almost all of these criteria require the pregnant woman to be in the fasting state in order to perform an oral glucose tolerance test (OGTT). In many parts of the world, especially in low- and middle-income countries, OGTT is a resource-intensive and technically demanding procedure. More often than not, pregnant women do not attend the antenatal clinic fasting. If they are asked to come fasting again for the OGTT, the drop-out rate is increased. Thus, for practical purposes, a test that is feasible on the ground is essential. In this paper, we emphasize a "single-test" procedure wherein a 75-gram oral glucose load is administered to the pregnant woman irrespective of whether she is in the fasting state or not, and plasma glucose is measured at two hours. A plasma glucose value ≥ 140 mg/dL (7.8 mmol/L) at two hours is considered diagnostic of GDM. The single-test procedure was found to be a sustainable, cost-effective, evidence-based, and affordable test procedure for any society. It serves both as a screening test and a diagnostic test for GDM. Furthermore, we emphasize the need for universal screening of all pregnant women who attend the antenatal clinics to detect dysglycemia, especially in the early weeks of pregnancy when the impact on the growing fetus would be significant.
近年来，糖尿病已演变成一种非传染性疾病大流行，数据显示全球每十名成年人中就有一人患有糖尿病。在导致糖尿病呈上升趋势的各种因素中，一个至关重要的因素是妊娠期糖尿病（GDM）。母亲的高血糖引发了一个恶性循环，不仅影响母亲和她的孩子，还会影响后代。有许多标准用于诊断GDM。几乎所有这些标准都要求孕妇处于空腹状态才能进行口服葡萄糖耐量试验（OGTT）。在世界许多地方，尤其是低收入和中等收入国家，OGTT是一项资源密集型且技术要求高的程序。通常情况下，孕妇不会空腹前往产前诊所。如果要求她们再次空腹前来进行OGTT，失访率会增加。因此，出于实际目的，一种在实际操作中可行的检测方法至关重要。在本文中，我们强调一种“单检测”程序，即无论孕妇是否处于空腹状态，都给其服用75克口服葡萄糖负荷，并在两小时后测量血糖。两小时时血糖值≥140毫克/分升（7.8毫摩尔/升）被认为可诊断为GDM。单检测程序被发现是一种对任何社会都可持续、具有成本效益、基于证据且负担得起的检测程序。它既作为GDM的筛查试验，也作为诊断试验。此外，我们强调需要对所有前往产前诊所的孕妇进行普遍筛查，以检测血糖异常，尤其是在怀孕早期，此时对发育中的胎儿的影响会很大。
