Test pregnant women and prevent future diabetes

28 FEBRUARY 2018 | Geneva

A woman in India having her finger pierced by a doctor in India
Looking for signs of diabetes already in pregnancy may become a tipping point in bending the curve of the diabetes pandemic, which is now reaching pandemic heights with 425 million people affected worldwide
Novo Nordisk/C. Nayak

"There are many good reasons for testing pregnant women for diabetes, says Rikke Fabienke, Senior Global Access to Care Manager at Novo Nordisk. In the immediate short term women get better maternal outcomes and in the long term, mothers and babies reduce their risk of developing life-long type 2 diabetes."

Uncontrolled blood sugar levels during pregnancy can result in diabetes later in life for both mother and child. Luckily, blood sugar can both be measured and controlled – in most cases lifestyle changes are enough, in rare cases medication is needed. Substantial evidence shows that controlling pregnant women’s blood sugar levels is key to delay or prevent future diabetes in mother and child. While measuring the blood sugar during pregnancy is standard procedure in high-income healthcare systems, it is still not common practice in some of the countries facing the heaviest diabetes burden.

Few people connect the dots

This is the case in India – home to the second largest diabetes population in the world (1). About 10-14% of all pregnant women in India are estimated to have diabetes in pregnancy (2); however, blood sugar testing is not yet a standard practice in large parts of the country. As a consequence, women go undiagnosed and experience complications during pregnancy and child birth, which often go unaccounted for – because no one connects the dots between diabetes and maternal health. This happened to Chaya who at the age of 34 lives with type 2 diabetes and has had three C-sections and one still birth. It was not until her third pregnancy that a healthcare professional checked her blood sugar levels and found that she had already developed diabetes.

Helping implement national guidelines

In 2014, the Indian Ministry of Health and Family Welfare introduced national guidelines for diagnosis and management of diabetes in pregnancy – gestational diabetes, also known as ‘GDM’. The same year, the Ministry asked Jhpiego, a non-profit health organization affiliated with The Johns Hopkins University, to help field test the guidelines. With support from Novo Nordisk this project was initiated in the Indian state of Madhya Pradesh with the aim of integrating GDM testing into antenatal care.

The project has tested more than 24,000 women of which nearly 2,200 (9%) have been diagnosed with gestational diabetes. A series of training aids and operational guidelines to accompany the national treatment guidelines have been developed, and going forward these will make up a great support for a broader roll-out across India. The project has also shed light on the relevance, and shared benefit, of a closer integration of maternal health and NCD prevention.

The most low-cost intervention

"Ultimately, we are working with partners to defeat diabetes. Addressing it already in pregnancy is the most low-cost intervention any healthcare authority can take, as it allows us to both improve maternal and child health and halt the diabetes pandemic before it becomes a lifelong burden for individuals and society as a whole," says Rikke Fabienke, Senior Global Access to Care Manager at Novo Nordisk.

The support to Jhpiego is part of Novo Nordisk’s broader work to raise awareness on the opportunities of addressing diabetes in pregnancy and to improve access to diagnosis and care. Other collaborating partners on this agenda currently include the International Federation of Gynecology and Obstetrics (FIGO) and Women Deliver.


References

(1) 72.9 million people between 20-79 years – a number that is estimated to rise to 134.4 million people by 2045 (International Diabetes Federation. IDF Diabetes Atlas, 8th edn. Brussels, Belgium: International Diabetes Federation, 2017).

(2) National Guidelines for Diagnosis & Management of Gestational Diabetes Mellitus, Maternal Health Division, Ministry of Health and Family Welfare, Government of India, December 2014.