21/05/2026
Happy to share our letter in the prestigious journal Diabetologia, written as a critical appraisal of the original work by Prof C. S. Yajnik and colleagues on whether gestational hyperglycaemia may reflect lifelong glycaemic patterns.
From our perspective, the key scientific messages were:
1. A rare and valuable life-course dataset
The original article provides an important longitudinal view of glycaemia from childhood to pregnancy, especially from an Indian cohort — a perspective that is scientifically valuable and globally relevant.
2. Gestational hyperglycaemia may reflect earlier metabolic patterns
The concept that pregnancy glycaemia may be linked to pre-pregnancy or childhood glycaemic traits is biologically plausible and deserves further exploration.
3. Association should not be overinterpreted as causation
Our appraisal emphasized that glycaemic tracking across life stages may indicate correlation, but it does not yet prove that gestational diabetes is a direct manifestation of lifelong dysglycaemia.
4. Methodological caution is essential
Small sample size, limited number of GDM cases, categorisation of continuous glycaemic variables, wide confidence intervals, and possible selection bias may affect the strength and precision of the conclusions.
5. Longitudinal data need robust longitudinal methods
Repeated glycaemic measurements across life stages should ideally be analysed using approaches that account for within-person correlation and glycaemic trajectories over time.
6. Generalisability remains an important question
The cohort consisted mainly of young, lean, rural Indian women. Extrapolation to urban, obese, insulin-resistant, or ethnically diverse populations should therefore be done carefully.
7. An exciting hypothesis, but not definitive yet
The idea that gestational hyperglycaemia reflects lifelong glycaemia is important and hypothesis-generating. Larger, diverse cohorts with harmonised diagnostic criteria, advanced longitudinal modelling, and mechanistic biomarkers are needed before it can be accepted as a definitive clinical framework.
Link to read our article: https://link.springer.com/article/10.1007/s00125-026-06745-y
Finally, it is my humble privilege to have this letter published in Diabetologia. I feel truly blessed to have been supervised and guided at every step of this critical appraisal by two doyens of world diabetes, Padmashree Dr Shashank Joshi and Padmashree Dr V. Mohan. Their wisdom, mentorship, and encouragement made this academic journey deeply meaningful.
