Source: Hindu

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Context

• A recent study proposes replacing the oral glucose tolerance test (OGTT) with a point-of-care HbA1c test for gestational diabetes screening.
• This approach could revolutionize screening by making it more accessible, especially in rural and remote areas.

Details

Proposed Screening Method

• Current Method (OGTT):
  • Administered between 24 and 28 weeks of pregnancy.
  • Requires fasting, consuming a 75 g glucose solution, and multiple blood draws over two to three hours.
  • Challenges include accessibility in remote areas and the time-consuming nature of the test.
• Proposed Method (HbA1c Test):
  • Can be administered in the first trimester.
  • Point-of-care testing allows for screening at home with a drop of blood.
  • HbA1c thresholds:
    • A result of 4.9 rules out gestational diabetes.
    • A result of 5.4 or above indicates gestational diabetes.
    • Intermediate results would require follow-up OGTT, estimated for 25% of pregnant women.

Benefits of HbA1c Screening

• Accessibility: Simplifies testing for women in rural or remote areas, eliminating the need for travel and multiple clinic visits.
• Early Intervention: Identifies high-risk groups early in pregnancy, allowing for timely intervention with diet and exercise.
• Cost Neutral: While the direct cost of HbA1c is currently higher, it is offset by savings in travel, lost wages, and broader usage potentially reducing costs over time.
• Reduction in OGTTs: Could reduce the need for OGTTs by 50% to 64%, making screening more efficient.

Gestational Diabetes

• Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy (gestation).
• Like other forms of diabetes, it affects how cells use glucose (sugar), leading to high blood sugar, which can impact both the mother's and baby's health.

Causes and Risk Factors

• Hormonal Changes: Pregnancy hormones can interfere with insulin's ability to manage blood glucose, causing insulin resistance.
• Risk Factors:
  • Obesity: Increased body fat affects insulin's effectiveness.
  • Age: Women over 25 are at higher risk.
  • Family History: A family history of diabetes increases risk.
  • Previous GDM: Having gestational diabetes in a previous pregnancy raises the risk.
  • Ethnicity: Higher prevalence in African American, Hispanic, Native American, and Asian women.

Symptoms

Gestational diabetes often presents with no symptoms or very mild ones, but possible signs include:

• Increased thirst
• Frequent urination
• Fatigue
• Nausea
• Blurred vision

Sources:

Hindu

PRACTICE QUESTION Q: With reference to diabetes mellitus, consider the following statements: Type 1 diabetes is characterized by the autoimmune destruction of beta cells in the pancreas, leading to an absolute insulin deficiency. In Type 2 diabetes, the primary problem is insulin resistance, although insulin secretion may also be impaired over time. Glycated hemoglobin (HbA1c) levels are used to diagnose diabetes, and an HbA1c level of 6.5% or higher on two separate tests indicates diabetes. Which of the statements given above is/are correct? a) 1 only b) 1 and 2 only c) 2 and 3 only d) 1, 2, and 3 Answer: d)