Comparison of DIPSI and IADPSG criteria for diagnosis of GDM: a study in a north Indian tertiary care center

Abstract

General diagnostic criteria used in our country for determination of gestational diabetes mellitus (GDM) involve Diabetes in Pregnancy Study Group India (DIPSI) and International Association of Diabetes and Pregnancy Study Groups (IADPSG) guidelines. DIPSI states that when a pregnant woman walks into the antenatal clinic in fasting state, she has to be given 75 g oral glucose load, and if 2-h plasma glucose (PG) is ≥140 mg/dL, then it is considered to be a case of GDM. The IADPSG after Hyperglycemia and Adverse Pregnancy Outcome (HAPO) recommends any of the values of fasting plasma glucose (FPG) ≥92 mg/dL, 1-h PG ≥180 mg/dL, or 2-h PG ≥153 mg/dL to diagnose GDM. Our objective was to study the implications of implementing the IADPSG guidelines or DIPSI guidelines for screening and diagnosis of GDM in Indian population. Another objective was to evaluate the importance of isolated fasting glucose which is the main difference between the two guidelines. This retro-prospective study was performed at the Max Super Speciality Hospital, Saket, Delhi. Consecutive pregnant women (N = 152) in 24th–28th week of pregnancy underwent 75 g oral glucose tolerance test (OGTT). The proportions of GDM computed by both IADPSG and DIPSI criteria were analyzed, and the discordant pair of diagnosing GDM was examined by McNemar test. A total of 152 pregnant women went through 75 g OGTT. Among them, 113 (74.34 %) were diagnosed with gestational diabetes as per the DIPSI criteria of 2 h post plasma glucose (PPG) ≥140 mg/dL while taking into account the isolated fasting blood glucose alone as per the IADPSG criteria 34 (22.36 %), women were diagnosed with GDM. Furthermore, by including 2-h plasma glucose (PG) ≥153 mg/dL, 69 (45.39 %) were detected with GDM. Diagnosis of GDM by DIPSI criteria leaves 22.36 % undiagnosed which may easily be detected through IADPSG. Since the DIPSI criteria would miss a substantial number of patients, we suggest that the IADPSG criteria are better for screening of GDM in India.