Editorial: Need for early intervention

Published in The Hindu on April 21, 2008

Foetus1
With all the focus on delaying or preventing the onset of the disease in adults, the fact that the foetus, when exposed to an elevated maternal glucose level, gets primed to develop diabetes at a later stage had been overlooked.

Tamil Nadu’s imaginative screening programme launched a year ago has proved highly beneficial in early detection and control of gestational diabetes. The largest such initiative, the programme involved screening pregnant women visiting government-run prenatal clinics. It is an example of how timely intervention that costs very little and enables easy management of the condition — the elevation of maternal blood glucose first seen during pregnancy — can help in reducing the risk of both mother and child becoming diabetic at a later stage. The prevalence of gestational diabetes among the 5.2 lakh pregnant women screened across the rural areas has been found to be 7-8 per cent. It is a pity that controlling elevated glucose during pregnancy, a simple strategic intervention, did not get due priority earlier. With all the focus on delaying or preventing the onset of the disease in adults, the fact that the foetus, when exposed to an elevated maternal glucose level, gets primed to develop diabetes at a later stage had been overlooked. The benefits of the latest intervention strategy will, of course, take many years to realise. That in nearly 90 per cent of the pregnant women diagnosed with gestational diabetes the glucose level could be kept under check through simple diet management is an undoubtedly heartening outcome. As more primary health centres get equipped to check for the condition, a larger proportion of the target group will be roped in. Of the total deliveries in Tamil Nadu, nearly 65 per cent take place in government hospitals, and screening these for gestational diabetes should not be difficult.

Several studies have established that elevated glucose levels can be detected through screening even as early as in the 16th week of pregnancy and that the condition shows up at all the trimesters. Significantly, 2-2.5 per cent of the gestational diabetes prevalence recorded during the Tamil Nadu programme was found in the 16th week, while 2.5-3 per cent cases were detected during the 24th week and around 3 per cent in the 32nd week. Unfortunately, in spite of the proven advantages, the medical fraternity is yet to adopt the concept of an early start of the screening procedure, with the process being repeated in subsequent visits. If at one level, the programme will go a long way in training the health workers in screening procedures, at another, the Tamil Nadu experience will hopefully give a push to the early-screening practice. For their part, governments should go all out to increase the awareness of private practitioners in this respect, encouraging them to fall in line.

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