Yashdeep Gupta1, Bharti Kalra2. 1. Department of Medicine, Government Medical College and Hospital, Chandigarh, India. 2. Department of Obstetrics and Gynaecology, Bharti Hospital, Karnal, Haryana, India.
Sir,Four million women are diagnosed with gestational diabetes mellitus (GDM) annually in India and 50% develop type 2 diabetes within 5 years of the index pregnancy.[1] This adds to the already existing huge burden of ‘diabetics’ (61.3 million in 2011), pressurizing the healthcare system in terms of both direct and indirect costs.With less stringent criteria recommended by American Diabetes Association (ADA) in 2011, prevalence of GDM is expected to rise further. Even the developed economies have concerns, in terms of dramatic increase in requirement of finances and healthcare resources to cater the additional burden of ‘gestational diabetics’. The calculations have not been made for India, but the concerns can be well foreseen.Can India benefit by investing at present for better future? Yes! Asians have an early onset of diabetes with more than one-third developing diabetes before the age of 44 years.[2] Thus, the opportunity for action for primary prevention is narrow for Asians. Glucose intolerance detected during pregnancy easily provides the population which is at risk for future diabetes and cardiovascular disease. Women with ‘gestational diabetes’ are very much receptive for diabetic education and a recent study in GDM found diabetes prevention interventions to be highly cost effective in India.[3]The cost effectiveness would increase further if the risk of subsequent diabetic complications in mother and adverse long - term outcomes in offspring are accounted for. Unfortunately, none of the cost effective analysis has taken this into account due to lack of well-designed trials to prove such benefits.By virtue of Indian culture, women enjoy a strategic position in household. The family practice of common kitchen gives her control for diet modification of family. Family history of diabetes, means additional family members from her parent's side afflicted with diabetes. Her offspring stands at high risk for obesity, diabetes, and cardiovascular disease in future. If she is imparted diabetic education about lifestyle modifications, empowered with other health promotion education and motivated regarding her important role in primary/secondary prevention of diabetes for the entire family; it will not only reduce risk of diabetes for her, but will also help in reducing risk for others.This will change her position from a socially stigmatized one to a role model in society and will mark the new dawn of diabetes care in India.