Diagnosing Gestational Diabetes by a Single-Test Procedure Is a Propitious Step Towards Containing the Epidemic of Diabetes

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.