Diagnostic efficacy of DIPSI criteria for diagnosis of gestational diabetes mellitus in comparison with WHO 2013 criteria
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20250168Keywords:
Gestational diabetes mellitus, Glucose tolerance test, DIPSIAbstract
Background: Gestational diabetes mellitus (GDM) is a global health issue due to its increasing prevalence and negative effects on maternal and fetal health. The standard screening method is the 75 g glucose tolerance test (OGTT), which requires fasting. The Diabetes in Pregnancy Study Group of India (DIPSI) suggests a one-stage, non-fasting test as an alternative, which could be more patient-friendly and aligns with international recommendations. This study aimed to assess the diagnostic efficacy of the DIPSI method compared to the WHO criteria for GDM screening.
Methods: This cross-sectional study was conducted from October 2021 to September 2022 at the Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. One hundred and thirty-three singleton pregnant women who provided informed consent were included.
Results: Among 133 participants, 34 (25.6%) were diagnosed with GDM according to WHO criteria, while 26 (19.5%) were diagnosed with DIPSI. The DIPSI method showed high specificity (96.97%) but lower sensitivity (67.65%) compared to the WHO criteria. The positive and negative likelihood ratios were 22.32 and 0.33, respectively, with an overall accuracy of 89.46%. Lowering the DIPSI cutoff to 7.3 mmol/L improved sensitivity to 82.4% and specificity to 92.9% and increased overall accuracy to 90.2%.
Conclusions: The non-fasting DIPSI method demonstrated reasonable diagnostic accuracy compared to the WHO criteria. It is recommended for use in low-resource settings but should not replace the gold standard OGTT for comprehensive GDM screening.
Metrics
References
World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy, 2013. Available at: WHO/NMH/MND/13.2:1-62. Accessed 01 May 2024.
Bernea EG, Mihai A, Pietrosel A, Ceausu I, Antohe F, Ionescu-Tirgoviste C. Maternal and Fetal Complications of Gestational Diabetes-Review. Res. & Sci. Today. 2020;suppl 1:55-65. DOI: https://doi.org/10.38173/RST.2020.S1.7:55-65
Mission JF, Catov J, Deihl TE, Feghali M, Scifres C. Early pregnancy diabetes screening and diagnosis: prevalence, rates of abnormal test results, and associated factors. Obstetr Gynecol. 2017;130(5):1136-1142. DOI: https://doi.org/10.1097/AOG.0000000000002277
Behboudi-Gandevani S, Amiri M, Yarandi RB, Tehrani FR. The impact of diagnostic criteria for gestational diabetes on its prevalence: a systematic review and meta-analysis. Diabetol Metabol Syndr. 2019;11(1):1-18. DOI: https://doi.org/10.1186/s13098-019-0406-1
Jiwani A, Marseille E, Lohse N, Damm P, Hod M, Kahn JG. Gestational diabetes mellitus: results from a survey of country prevalence and practices. J Mat-Fet Neonatal Medi. 2012;25(6):600-10. DOI: https://doi.org/10.3109/14767058.2011.587921
Yan J, Su R, Ao D, Wang Y, Wang H, Yang H. Genetic variants and clinical relevance associated with gestational diabetes mellitus in Chinese women: a case-control study. J Maternal-Fetal Neonat Medi. 2018;31(16):2115-2121. DOI: https://doi.org/10.1080/14767058.2017.1336225
Nguyen CL, Pham NM, Binns CW, Duong DV, Lee AH. Prevalence of gestational diabetes mellitus in eastern and southeastern Asia: a systematic review and meta-analysis. J Diab Res. 2018;2018:1-10. DOI: https://doi.org/10.1155/2018/6536974
Casagrande SS, Linder B, Cowie CC. Prevalence of gestational diabetes and subsequent Type 2 diabetes among U.S. women. Diab Res Clin Pract. 2018;141:200-208. DOI: https://doi.org/10.1016/j.diabres.2018.05.010
Walsh S, Mahmoud M, Htun H, Hodgett S, Barton D. A comparison of follow-up rates of women with gestational diabetes before and after the updated National Institute for Health and Care Excellence guidance advocating routine follow-up, and the association with neighbourhood deprivation. Brit J Diabet. 2019;19(1):14-18. DOI: https://doi.org/10.15277/bjd.2019.202
Khan S, Bal H, Khan ID, Paul D. Evaluation of the diabetes in pregnancy study group of India criteria and Carpenter-Coustan criteria in the diagnosis of gestational diabetes mellitus. Turk J Obstetr Gynecol. 2018; 15(2):75-79. DOI: https://doi.org/10.4274/tjod.57255
Jesmin S, Akter S, Akashi H, Al-Mamun A, Rahman MA, Islam MM, et al. Screening for gestational diabetes mellitus and its prevalence in Bangladesh. Diab Res Clin Pract. 2014;103(1):57-62. DOI: https://doi.org/10.1016/j.diabres.2013.11.024
Arias F, Bhide AG, Arulkumaran S, Damania K, Daftary SN. Arias' Practical Guide to High-Risk Pregnancy and Delivery: A South Asian Perspective. 5th ed. Amsterdam: Elsevier Health Sciences; 2019.
Di Cianni G, Miccoli R, Volpe L, Lencioni C, Del Prato S. Intermediate metabolism in normal pregnancy and in gestational diabetes. Diabet/Metaboli Res Revi. 2003;19(4):259-270. DOI: https://doi.org/10.1002/dmrr.390
Santangelo C, Zicari A, Mandosi E, Scazzocchio B, Mari E, Morano S, et al. Could gestational diabetes mellitus be managed through dietary bioactive compounds? Current knowledge and future perspectives. Brit J Nutrit. 2016;115(7):1129-1144. DOI: https://doi.org/10.1017/S0007114516000222
Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The pathophysiology of gestational diabetes mellitus. Int J Mole Sci. 2018;19(11):1-21. DOI: https://doi.org/10.3390/ijms19113342
Kampmann U, Knorr S, Fuglsang J, Ovesen P. Determinants of maternal insulin resistance during pregnancy: an updated overview. J Diab Res. 2019;2019:1-10. DOI: https://doi.org/10.1155/2019/5320156
Barbour LA, McCurdy CE, Hernandez TL, Kirwan JP, Catalano PM, Friedman JE. Cellular mechanisms for insulin resistance in normal pregnancy and gestational diabetes. Diabetes Care. 2007;30(Suppl 2):S112-S119. DOI: https://doi.org/10.2337/dc07-s202
Zhu C, Yang H, Geng Q, Ma Q, Long Y, Zhou C, et al. Association of oxidative stress biomarkers with gestational diabetes mellitus in pregnant women: a case-control study. PloS One. 2015;10(4):1-12. DOI: https://doi.org/10.1371/journal.pone.0126490
Lee KW, Ching SM, Ramachandran V, Yee A, Hoo FK, Chia YC, et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnan Child. 2018;18(1):1-20. DOI: https://doi.org/10.1186/s12884-018-2131-4
Seshiah V, Das A, Balaji V, Joshi SR, Parikh M, Gupta S. Gestational diabetes mellitus-guidelines. JAPI. 2006;54:622-8.
Saxena P, Verma P, Goswami B. Comparison of diagnostic accuracy of non-fasting DIPSI and HbA1c with fasting WHO criteria for diagnosis of gestational diabetes mellitus. J Obstetr Gynaecol India. 2017;67(5):337-42. DOI: https://doi.org/10.1007/s13224-017-0962-y
Shrestha B, Pokhrel L. Comparative study of DIPSI and WHO 2018 criteria for diagnosis of GDM. Nepal Medi Coll J. 2020;22(1-2):13-7. DOI: https://doi.org/10.3126/nmcj.v22i1-2.30023
Koning SH, van Zanden JJ, Hoogenberg K, Lutgers HL, Klomp AW, Korteweg FJ, et al. New diagnostic criteria for gestational diabetes mellitus and their impact on the number of diagnoses and pregnancy outcomes. Diabetol. 2018;61(4):800-9. DOI: https://doi.org/10.1007/s00125-017-4506-x
Stewart A, Malhotra A. Gestational diabetes and the neonate: challenges and solutions. Res Rep Neonatol. 2015;5:31-39. DOI: https://doi.org/10.2147/RRN.S30971
Gasim T. Gestational diabetes mellitus: maternal and perinatal outcomes in 220 saudi women. Oman Medi J. 2012;27(2):140-4. DOI: https://doi.org/10.5001/omj.2012.29
Rani PR, Begum J. Screening and diagnosis of gestational diabetes mellitus, where do we stand. J Clin Diagnos Res. 2016;10(4):Qe01-04. DOI: https://doi.org/10.7860/JCDR/2016/17588.7689
Nusrat-Sultana M, Hasanat M-H, Yasmin-Aktar S-P, Sharmin-Jahan MF. Screening for gestational diabetes mellitus (GDM): Comparison between WHO 1999 and modified O’Sullivan Criteria. JCD. 2015;2(2):21-6.
Sandesh-Panthi MA, Hasanat M-H, Yasmin-Aktar N-S, Sharmin-Jahan MF. Frequency of gestational diabetes mellitus in Bangladesh impact of WHO 2013 screening criteria: Efficiency DIPSI & WHO 1999 criteria. JCD. 2015;2(2):13-9.
Anjalakshi C, Balaji V, Balaji MS, Ashalata S, Suganthi S, Arthi T, et al. A single test procedure to diagnose gestational diabetes mellitus. Acta Diabetol. 2009;46(1):51-4. DOI: https://doi.org/10.1007/s00592-008-0060-9
Sharma K, Wahi P, Gupta A, Jandial K, Bhagat R, Gupta R, et al. Single glucose challenge test procedure for diagnosis of gestational diabetes mellitus: a Jammu cohort study. J Associ Phy India. 2013;61(8):558-9.
Mohan V, Mahalakshmi MM, Bhavadharini B, Maheswari K, Kalaiyarasi G, Anjana RM, et al. Comparison of screening for gestational diabetes mellitus by oral glucose tolerance tests done in the non-fasting (random) and fasting states. Acta Diabetologica. 2014;51(6):1007-13. DOI: https://doi.org/10.1007/s00592-014-0660-5
Vij P, Jha S, Gupta S, Aneja A, Mathur R, Waghdhare S, et al. Comparison of DIPSI and IADPSG criteria for diagnosis of GDM: a study in a north Indian tertiary care center. Int J Diabet Develop Countr. 2015;35(3):285-8. DOI: https://doi.org/10.1007/s13410-014-0244-5
Junnare KK, Adhau SR, Hegde MV, Naphade PR. Screening of gestational diabetes mellitus in antenatal women using DIPSI guidelines. IJRMS. 2016;4:446-9. DOI: https://doi.org/10.18203/2320-6012.ijrms20160293
Tripathi R, Verma D, Gupta VK, Tyagi S, Kalaivani M, Ramji S, et al. Evaluation of 75 g glucose load in non-fasting state [Diabetes in Pregnancy Study group of India (DIPSI) criteria] as a diagnostic test for gestational diabetes mellitus. Ind J Medi Res. 2017;145(2):209-14. DOI: https://doi.org/10.4103/ijmr.IJMR_1716_15
Basnet T, Pradhan N, Koirala P, Bista KD. Evaluation of glucose challenge test using cut off values 130mg/dl and 140 mg/dl for gestational diabetes mellitus screening. Inter J Reproduct Contracept Obstetr Gynecol. 2018;7(3):801-5. DOI: https://doi.org/10.18203/2320-1770.ijrcog20180858
Rudra S, Yadav A. Efficacy of Diabetes in Pregnancy Study Group India as a Diagnostic Tool for Gestational Diabetes Mellitus in a Rural Setup in North India. J South Asian Federat Obstetr Gynaecol. 2019;11(6):349-52. DOI: https://doi.org/10.5005/jp-journals-10006-1731
Downloads
Published
How to Cite
Issue
Section
