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Review Diabetes Gestational Diabetes Mellitus—Triage for Preventive Intervention Achini Wijesinghe, 1 Sonali Gunatilake, 2 Dina Shrestha, 3 Yashdeep Gupta, 4 Noel Somasundaram, 1 Uditha Bulugahapitiya, 2 and Sanjay Kalra 5 1. Department of Endocrinology, National Hospital of Sri Lanka, Sri Lanka; 2. Department of Endocrinology, Colombo South Teaching Hospital, Colombo, Sri Lanka; 3. Department of Endocrinology, Norvic Hospital, Kathmandu, Nepal; 4. Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India; 5. Department of Endocrinology, Bharti Hospital, Karnal, India G estational diabetes mellitus (GDM) is a heterogeneous condition, as exemplified by our inability to agree upon screening and diagnostic criteria. Not all women with GDM carry the same long-term risk of diabetes. We therefore propose a triage system to identify women with GDM who are at higher risk of converting to diabetes mellitus, in a shorter time frame after pregnancy. Such women can be offered personalized risk assessment information. Keywords Gestational diabetes mellitus, GDM, triage, postpartum, diabetes Disclosure: Achini Wijesinghe, Sonali Gunatilake, Dina Shrestha, Yashdeep Gupta, Noel Somasundaram, Uditha Bulugahapitiya, and Sanjay Kalra have nothing to disclose in relation to this article. No funding was received for the publication of this article. Compliance with Ethics: This article involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: November 3, 2016 Accepted: December 12, 2016 Citation: US Endocrinology, 2016;12(2):99–101 Corresponding Author: Yashdeep Gupta, Room No 308, Biotechnology building, Department of Endocrinology & Metabolism, AIIMS, New Delhi 110029, India. E: yash_deep_gupta@yahoo.co.in Women with gestational diabetes mellitus (GDM) carry a multidimensional and trans-generational impact. 1 It poses a huge medical and public health burden on society today, which can be mitigated if appropriate proactive and preventive strategies are put in place. These include early screening and identification of women with GDM, provision of appropriate non-pharmacological and pharmacological therapy, and regular follow up after delivery to detect and treat diabetes in a timely manner. GDM is similar to pre-diabetes in many ways. 2,3 Though it differs because of its association with pregnancy, the pathophysiologic features are the same as those operating in impaired glucose tolerance. Studies have reported that women with GDM are several times more likely to develop subsequent type 2 diabetes mellitus (T2DM) compared to women without GDM, with approximately 50% developing diabetes within 10 years. 4 Asian Indians stand at higher risk for earlier conversion to diabetes, compared to Caucasians. Studies from India have found high conversion rates to T2DM even within five years of delivery. 5–8 This reality has made GDM screening, diagnosis, management, and postpartum follow-up an international public health priority. Triage system GDM is a heterogeneous condition, as exemplified by our inability to agree upon screening and diagnostic criteria. 3 Not all women with GDM carry the same long term risk of diabetes. We therefore propose a triage system to identify women with GDM who are at higher risk of converting to diabetes mellitus, in a shorter time frame after pregnancy. Such women can be offered personalized risk assessment information. 9 Women at higher risk should be encouraged to breastfeed their infants, 10 called for relatively frequent follow-up, supported with intensive lifestyle modification advice, and prescribed preventive pharmacotherapy. The health care system can use its limited resources to focus on these high risk women, and achieve greater public health benefits with a targeted approach. Determinants of risk A recent meta-analysis assessed 39 relevant studies on GDM, including 95,750 women. 11 Body Mass Index (BMI) (realtive risk [RR] 1.95 [95% confidence interval (CI) 1.60, 2.31]), family history of diabetes (RR 1.70 [95% CI 1.47, 1.97]), non-white ethnicity (RR 1.49 [95% CI 1.14, 1.94]) and advanced maternal age (RR 1.20 [95% CI 1.09, 1.34]) were associated with future risk of T2DM. There was an increase in risk with early diagnosis of GDM (RR 2.13 [95% CI 1.52, 3.56]), raised fasting glucose (RR 3.57 [95% CI 2.98, 4.04]), increased glycated hemoglobin (HbA 1c ) (RR 2.56 [95% CI 2.00, 3.17]) and use of insulin (RR 3.66 [95% CI 2.78, 4.82]). Multiparity (RR 1.23 [95% CI 1.01, 1.50]), hypertensive disorders in pregnancy (RR 1.38 [95% CI 1.32, 1.45]) and preterm delivery (RR 1.81 [95% CI 1.35, 2.43]) TOU CH MED ICA L MEDIA 99