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Primordial Prevention of Diabetes and its Comorbid Complications

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Prof (Dr) V Seshiah, Chennai    01 February 2018

should start during intrauterine period and continue throughout life from early childhood. GDM offers an important opportunity for the development, testing and implementation of the clinical strategies for prevention of diabetes and NCDs.

Insulin resistance, increased atherogenic lipid profile, inflammatory markers, hypertension and endothelial dysfunction lead to increased risk for CVD.

A substantial number of women with GDM have increased lifetime risk of developing diabetes at over three times compared to control after 16 years of index pregnancy. By 17 years of age, one-third of children born to GDM mothers have had evidence of prediabetes, T2DM, metabolic syndrome, impaired insulin sensitivity and secretion.

For diagnosis of GDM, single step testing using 75 g oral glucose and measuring plasma glucose 2-hour after ingestion is recommended. The threshold plasma glucose level of >140 mg/dl (≥140) is taken as cut-off for diagnosis of GDM.

Timely action taken now in screening all pregnant women for glucose tolerance, achieving euglycemia in them, may prevent the epidemic of NCDs. Maternal health is the link to the NCD epidemic. Low birth weight or large for gestational age birth weight leads to elevated risk for obesity, diabetes, hypertension, CVD in adult life.

There is an intergenerational transfer of risk. Postpartum follow-up is very essential and pre-GDM women should be advised against gaining weight. Similarly, their offsprings should also follow a healthy lifestyle pattern.

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