Dr Gupta et al rightly point out that screening for and treatment of gestational diabetes mellitus (GDM) ideally serves 2 purposes: (1) short-term maternal and perinatal outcome and (2) long-term outcome. In their letter they concentrate on long-term maternal outcome: identification of minor degrees of glucose intolerance during pregnancy, using strict glucose threshold values, may identify an additional group of women destined to develop type-2 diabetes later in life. This is especially important in a country like India, with a high prevalence of type 2 diabetes occurring rather early in life. We agree with their reasoning. However, when using very strict criteria, many of these women will unnecessarily be labeled and stigmatized as being at high risk for later diabetes.

In our paper, we promote a more individualized approach to screening for GDM by including other risk factors, such as body mass index and family history. This may be refined by assessing the degree of abdominal fat by ultrasound and obesity-related insulin resistance by calculating homeostasis model assessment and biomarkers such as adiponectin. In our opinion, research should focus on integrated testing by taking these factors into account to identify women really at risk for long-term morbidity. Finally, the authors suggest that lifestyle changes may prevent or delay occurrence of type 2 diabetes. That seems true, but much effort is required to implement and maintain a systematic, effective, and affordable system to prevent type 2 diabetes after GDM, indicating that an approach targeting the highest-risk populations is desirable.