For many years, there has been a divergence of opinion as to whether it was worth treating gestational diabetes. This controversy seemed to have been settled following the publication of the ACHOIS study in 2005 which showed that peri-natal complications were lower in the treatment group. In the UK, diagnostic and treatment guidelines for gestational diabetes were published by NICE in 2009 (most clinics use a 2hr oral glucose tolerance test glucose value >7.8mmol/l).

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Although the prevalence of Type 2 diabetes (T2DM) in the general population, is approximately 5%, in some areas with significant S Asian communities, it is often 7-8% or often higher due to their increased susceptibility. In fact, by age 80 years, 50% of south Asians have diabetes, with a younger age of onset (10 years earlier) and greater effect on renal and cardiovascular outcomes than European comparators. The reason for this is a combination of genetic and environmental factors. S Asian patients tend to have a higher prevalence of the metabolic syndrome (comprising insulin resistance, hypertension, central obesity and dyslipidaemia).Insulin resistance in this population may appear as early as childhood and supports the concept (at least in part) of a genetic predisposition. This is certainly seen in antenatal clinics where there is a significant preponderance of Asian patients developing gestational diabetes. Fat distribution also differs between white and Asian patients, the latter having an increased level of intra-abdominal (Atherogenic) fat for a given BMI. This has lead to recent NICE guidance on CVD risk in Asian patients. However, it is worth pointing out that the multinational INTERHEART study showed that 80% of CV risk is due to traditional risk factors such as hypertension and an atherogenic lipid profile of low HDL cholesterol and higher triglycerides. . Furthermore, high levels of homocysteine and Lp(a), endothelial dysfunction, and inflammation may also be contributing factors. The other proposed mechanisms include disadvantaged socio-economic status, a ‘proatherogenic’ diet and a relative lack of physical activity.

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