Screening for gestational diabetes has got a shot in the arm. All pregnant women in Tamil Nadu will soon be screened for gestational diabetes elevation of a woman’s blood glucose level for the first time and during pregnancy.
The decision by the State Government comes close on the heels of a large-scale study undertaken by Dr. V. Seshiah of Dr. V. Seshiah Diabetes Care and Research Institute, Chennai and Dr. V. Balaji, Consultant Diabetologist at Apollo Hospitals, Chennai.
A large study
The study involved nearly 7,000 pregnant women in Chennai representing the urban population and in Tiruvallur district representing the rural population.
The prevalence of gestational diabetes in the urban population was found to be 17.8 per cent; it was 10.4 per cent in the case of the rural population. “The State Government helped us to undertake this study,” stressed Dr. Seshiah. “Without their help we couldn’t have done it.”
The prevalence rate compares well with an earlier study undertaken by Dr. Seshiah, Dr. Balaji and others and published in the Journal of the Association of Physicians of India in 2004. The prevalence rate was found to be 16.2 per cent. Screening and treating for gestational diabetes has twin advantages it prevents the priming of the child, even at a foetal stage, to becoming diabetic at a later age and, of course, the mother from the same condition (The Hindu, October 21, 2004).
If the chances of two individuals becoming diabetic due to gestational diabetes are high, all it takes to prevent them from becoming so is by controlling the blood sugar during pregnancy.
And controlling blood sugar is very simple. “[The condition of] 95 per cent of those diagnosed with gestational diabetes could be controlled by simple diet management. Only 5 per cent required insulin,” said Dr. Balaji. Diet management simply means that the pregnant women need to avoid a large meal and instead take two smaller meals. “It is redistribution of calories,” explained Dr. Balaji.
The study also showed that screening even as early as the 16th week helped. “Almost 40 per cent were diagnosed by the 16th week,” Dr. Balaji noted. The point is to do the testing as early as possible as any delay will certainly produce some irreversible damage to the foetus and the mother.
But with the aim of catching the maximum number of women, the Government has planned to screen during the 24-28 week by doing a glucose tolerance test (GTT). Sugar level above 140 mg/dl after 2 hours of taking 75 gm glucose is indicative of gestational diabetes.
During treatment, post-prandial tests are done after one-and-half hours. And that is because, unlike normal women, pregnant women’s blood sugar level peaks after one-and-half hours of taking a meal. Sugar level not exceeding 120mg/dl is to be maintained while treating pregnant women. The two doctors have been instrumental in building awareness and training the doctors from the primary health centres. About 90 people have been trained so far.
Training the doctors
“Our plan is to train 45 doctors, one doctor from each health district,” said Dr. P. Padmanaban, Director of Public Health and Preventive Medicine, Government of Tamil Nadu. With these doctors training other doctors, 385 doctors will finally be trained across the State, according to Dr. Padmanaban. The government is putting in place the semi auto analysers required for testing blood sugar and training laboratory technicians as well.
What is indeed very significant is the percentage of women who will stand to benefit by the Government’s decision. “[About] 60 per cent of the 11.5 deliveries [in Tamil Nadu] are taking place in government institutions,” noted Dr. Padmanaban. “In Kerala, only about 25 per cent of deliveries take place in government institutions.”
With a prevalence of 17.8 per cent in urban and 10.4 per cent in rural areas, and with nearly 60 per cent deliveries taking place in government institutions, the number of women with gestational diabetes who will stand to benefit is staggering. But at what cost? Equipping all the 385 health districts with semi auto analysers will cost Rs.2 crore and according to Dr. Padmanaban, the recurring cost towards reagents will be about Rs.60 lakh per year. The cost is insignificant compared with the benefits accruing to the society.