Background: Women with prior Gestational Diabetes Mellitus (GDM) and Polycystic Ovary Syndrome (PCOS) have a 7-fold and 3-fold higher risk of future Type 2 diabetes, yet the Indian Diabetes Risk Score (IDRS) omits both. Young women <35 years are thus misclassified as low-risk.

Methods: We developed gender-enhanced BRS-D by adding history of GDM (1 point) and PCOS (1 point) to core variables. Multicentric prospective observational study across 4 zones of India, n=1054, HbA1c as gold standard (diabetes ≥6.5%, prediabetes 5.7-6.4%). Focused analysis on women with GDM/PCOS.

Result: Dysglycemia prevalence 83.9% (567 diabetes, 317 prediabetes). Among women with GDM/PCOS history, 94% had HbA1c-defined dysglycemia despite a mean age of 32.4 y and a waist below the IDRS obesity cut-off. IDRS labeled 41% of these women as low-moderate risk. BRS-D with GDM+PCOS reclassified 96.2% correctly as high-risk (≥4). Overall BRS-D sensitivity 92.65% vs IDRS 65.72% vs ADA 46.38%; accuracy 80.27% vs 63.85% vs 50.76%. Figure 1. BRS-D vs IDRS vs ADA performance and dysglycemia burden in the GDM/PCOS subgroup.

Conclusion: Integrating GDM and PCOS makes BRS-D a truly gender-sensitive, first-line screening tool that rescues young women otherwise missed.

Basavaraj G. S. is a distinguished Senior Consultant in Endocrinology, Diabetes & Obesity at Narayana Health, Bengaluru, and a PhD Scholar at Maastricht University, Netherlands. He is the Founder & Medical Director of Shashi Advanced Health and EQUA – Centre of Excellence for Obesity Care, and serves as Chief Clinical Innovation Officer at Pluxo.ai. With 50+ scholarly outputs, 150+ citations, and an h-index of 5, he has made significant contributions to endocrine and metabolic research. He received the Young Innovator Award, RSSDI 2023, and the Bronze Medal for Academic Excellence at PGIMER in 2012. He serves as an Executive Committee Member of the Endocrine Society of India (ESI, 2024–2027) and National Convener of the ESI Cardio-Metabolic Health Task Force. He is also the Organising Secretary of BEACON & ENDOesity School, Honorary Secretary of SSC, and Founder & Associate Editor of ABODE Journal. His research and clinical trial leadership include the Narayana Heart Cohort (~2,000 patients), BRS-D, PANORAMA, REDEFINE 3, EMPEROR-Preserved, and EMPACT-MIstudies.