IAS Gyan

Daily News Analysis


1st July, 2024 Health


Source: Hindu

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  • A recent study proposes replacing the oral glucose tolerance test (OGTT) with a point-of-care HbA1c test for gestational diabetes screening.
  • This approach could revolutionize screening by making it more accessible, especially in rural and remote areas.


Proposed Screening Method

  • Current Method (OGTT):
    • Administered between 24 and 28 weeks of pregnancy.
    • Requires fasting, consuming a 75 g glucose solution, and multiple blood draws over two to three hours.
    • Challenges include accessibility in remote areas and the time-consuming nature of the test.
  • Proposed Method (HbA1c Test):
    • Can be administered in the first trimester.
    • Point-of-care testing allows for screening at home with a drop of blood.
    • HbA1c thresholds:
      • A result of 4.9 rules out gestational diabetes.
      • A result of 5.4 or above indicates gestational diabetes.
      • Intermediate results would require follow-up OGTT, estimated for 25% of pregnant women.

Benefits of HbA1c Screening

  • Accessibility: Simplifies testing for women in rural or remote areas, eliminating the need for travel and multiple clinic visits.
  • Early Intervention: Identifies high-risk groups early in pregnancy, allowing for timely intervention with diet and exercise.
  • Cost Neutral: While the direct cost of HbA1c is currently higher, it is offset by savings in travel, lost wages, and broader usage potentially reducing costs over time.
  • Reduction in OGTTs: Could reduce the need for OGTTs by 50% to 64%, making screening more efficient.

Gestational Diabetes

  • Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy (gestation).
  • Like other forms of diabetes, it affects how cells use glucose (sugar), leading to high blood sugar, which can impact both the mother's and baby's health.

Causes and Risk Factors

  • Hormonal Changes: Pregnancy hormones can interfere with insulin's ability to manage blood glucose, causing insulin resistance.
  • Risk Factors:
    • Obesity: Increased body fat affects insulin's effectiveness.
    • Age: Women over 25 are at higher risk.
    • Family History: A family history of diabetes increases risk.
    • Previous GDM: Having gestational diabetes in a previous pregnancy raises the risk.
    • Ethnicity: Higher prevalence in African American, Hispanic, Native American, and Asian women.


Gestational diabetes often presents with no symptoms or very mild ones, but possible signs include:

  • Increased thirst
  • Frequent urination
  • Fatigue
  • Nausea
  • Blurred vision




Q: With reference to diabetes mellitus, consider the following statements:

  1. Type 1 diabetes is characterized by the autoimmune destruction of beta cells in the pancreas, leading to an absolute insulin deficiency.
  2. In Type 2 diabetes, the primary problem is insulin resistance, although insulin secretion may also be impaired over time.
  3. Glycated hemoglobin (HbA1c) levels are used to diagnose diabetes, and an HbA1c level of 6.5% or higher on two separate tests indicates diabetes.

Which of the statements given above is/are correct?

a) 1 only
b) 1 and 2 only
c) 2 and 3 only
d) 1, 2, and 3

Answer: d)