Diabetes: gestational diabetes in the Indian setting: practice question

A PSM question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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PSM · Diabetes: gestational diabetes in the Indian setting

Sample item

A woman at 26 weeks of gestation attends an antenatal clinic in a resource-limited setting. Without fasting, she drinks 75 g of glucose and her 2-hour plasma glucose is 152 mg/dL. Using the single-step approach recommended in India (DIPSI), what is the interpretation and next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Gestational diabetes is diagnosed; start medical nutrition therapy with glucose monitoring

The DIPSI approach uses a 75 g oral glucose load irrespective of fasting, with a 2-hour plasma glucose of 140 mg/dL or more diagnostic of gestational diabetes. The woman needs medical nutrition therapy and glucose monitoring, with drugs added if targets are not met. A single test avoids loss to follow-up in busy antenatal clinics.

Option by option

  • A. Overt diabetes; start insulin immediately

    Insulin is not the first step for a newly diagnosed gestational case, and the value does not by itself indicate overt diabetes.

  • B. Gestational diabetes is diagnosed; start medical nutrition therapy with glucose monitoring (correct)

    Correct. A 2-hour value of 152 mg/dL is at or above the 140 mg/dL cut-off.

  • C. Equivocal result; confirm with a 100 g three-hour glucose tolerance test

    The single-step test is diagnostic and needs no confirmatory 100 g test.

  • D. Normal result; repeat the test at 32 weeks

    A value of 152 mg/dL is already above the cut-off, so waiting would delay care.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More PSM questions

Questions about this PSM question

What is the answer to this PSM question?

The best answer is B, Gestational diabetes is diagnosed; start medical nutrition therapy with glucose monitoring. The DIPSI approach uses a 75 g oral glucose load irrespective of fasting, with a 2-hour plasma glucose of 140 mg/dL or more diagnostic of gestational diabetes.

Why is "Overt diabetes; start insulin immediately" not the answer?

Insulin is not the first step for a newly diagnosed gestational case, and the value does not by itself indicate overt diabetes.

Why is "Equivocal result; confirm with a 100 g three-hour glucose tolerance t…" not the answer?

The single-step test is diagnostic and needs no confirmatory 100 g test.

Why is "Normal result; repeat the test at 32 weeks" not the answer?

A value of 152 mg/dL is already above the cut-off, so waiting would delay care.

What concept does this question test?

It tests Diabetes: gestational diabetes in the Indian setting in PSM. The woman needs medical nutrition therapy and glucose monitoring, with drugs added if targets are not met. A single test avoids loss to follow-up in busy antenatal clinics.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Diabetes: gestational diabetes in the Indian setting?

Practise biostatistics with small calculations until sensitivity, predictive values and risk measures are automatic. Then use the flashcards and the other PSM questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.