Monitoring Gestational Diabetes

"The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of gestational diabetes is made" - Hidehiro Itokawa Chairman & CFO, Arkray Piramal Private Limited

Chronic diseases are growing at an alarming rate and are fast emerging as one of the top causes of death in the world. As per the latest WHO (World Health Organisation) report, the mortality rates of non-communicable diseases have seen a significant rise and will soon make up more than 30 per cent of deaths worldwide. The numbers of people affected by such lifestyle diseases are startling. Diabetes alone affects over 246 million people in the world out of which over 40.9 million people affected reside in India. Diabetes is the fourth leading cause of global death by disease with an annual figure of 3.8 million deaths. This epidemic with a negative impact on both developed and developing worlds, needs to be redressed immediately.

Factors behind the epidemic spread of diabetes are plenty but the three elements that lead the way to this disease are lifestyle, diet and genetic predisposition. Drastic changes in our lifestyle and the comforts brought to it by industrialisation have reduced physical activity. This is most often accompanied by unhealthy and calorie rich food. In fact, diabetes is fast emerging as one of the biggest health catastrophes the world has ever seen.

Diabetes is a disease that affects the body's ability to use simple sugars (glucose) from digested foods to produce energy. This causes blood glucose to build up in the blood, where it can damage the heart, kidneys, eyes and nerves. If untreated, diabetes can cause serious complications including heart disease, blindness, kidney failure and limb amputations. Common types of diabetes are type I, type II and gestational diabetes. Fortunately today, type I and type II are diabetes widely written about and there is a phenomenal increase in the levels of awareness but gestational diabetes still lags behind in this context.

Gestational diabetes develops only during pregnancy. Women who have had gestational diabetes have a 20 to 50 per cent chance of developing type II diabetes within five to 10 years. In an ideal scenario, most women around the 24th-26th week women should be tested for gestational diabetes, however it is a practice that needs to be inculcated amongst the practising gynaecologists in India.

Gestational diabetes increases the risk of complications for the mother and the foetus, however most complications of diabetes are usually manageable and preventable. Unlike type II diabetes, gestational diabetes generally does not cause birth defects. In most cases, birth defects usually originate sometime during the first trimester of pregnancy. They are more likely in women with pre-existing diabetes, who may have changes in blood glucose during that time. Women with gestational diabetes generally have normal blood sugar levels during the critical first trimester.

The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of gestational diabetes is made. It is recommended that women with gestational diabetes should monitor their blood glucose levels at least five times a day. The concept of Self Monitoring of Blood Glucose (SMBG) is a preventive measure which is encouraged in most developed countries, but compared to the 22 per cent in developed countries, SMBG is a concern with diabetics in India as only 0.3 per cent of them are actually aware of SMBG. The other practises that one needs to follow are eating a healthy diet, regular and moderate physical activity, maintaining a healthy weight and most importantly keeping daily records of diet, physical activity and glucose levels. Women with gestational diabetes should record their blood sugar numbers, physical activity, and everything they eat as this helps in tracking how well the treatment is working and if anything, needs to be changed.

SMBG is extremely important for patients with diabetes mellitus, in order to gain a better understanding of their blood glucose levels throughout their day-to-day activities and to help determine their insulin requirements. Even more so, this practice is crucial for women with gestational diabetes. Blood glucose control in pregnancies complicated by diabetes directly determines the well-being of both the mother and infant. Earlier monitoring blood glucose was burdensome, difficult, and imprecise, often resulting in poor outcomes, including early termination. Pregnancies complicated by diabetes often produced offspring who suffered from a variety of complications, including congenital malformations, macrosomia, and complications related to birth trauma. Over time, SMBG has become increasingly simplified with accurate and convenient monitoring devices whose operation is easily taught and performed. These small devises, used in the convenience and privacy of the patient's residence enable her to accurately monitor blood glucose. Being able to accurately record daily blood glucose measurements and their fluctuations is important to assess the level of control and to prescribe optimal insulin routine in order to minimise these complications.

The India medical devices and diagnostic market has evolved significantly in the last few years. Today it is valued at Rs 125.87 billion (source: Indian Diagnostics Report March 2008, Research and Markets). Glucose meters have evolved; the ones available now use the latest biosensor technology and provide accurate results. The devices are small and portable; one can sit in the convenience of their house and carry out these tests conveniently and economically.

Email: itokawah@arkray.co.jp
Chairman & CFO, Arkray Piramal Private Limited