Lack of uniformity in screening, diagnosis and management of gestational diabetes mellitus among health practitioners across major cities of Pakistan.

Syed Hunain Riaz,Muhammad Shais Khan,Ali Jawa,Javed Akram,Madeeha Hassan

doi:10.12669/pjms.342.12213

Abstract

Objective:To determine knowledge, attitude and practice (KAP) regarding management of Gestational Diabetes Mellitus (GDM) among Health Care Providers in major cities of Pakistan.Methods:A knowledge, attitude and practice (KAP) questionnaire based study was conducted in major cities in Pakistan from health care providers in public and private hospitals and clinics. Questionnaires were provided to the health care providers regarding screening, diagnosis and management of patients with GDM. Data analysis was done using IBM SPSS 20.Results:A total of 210 doctors took part in the study. 55 (26%) reported using fasting blood glucose as screening test for GDM whereas 129(61.4%) respondents used Oral Glucose Tolerance based WHO criteria for diagnosing GDM. Thirty six (17%) and 98(46.7%) doctors referred their patients to Gynecologists. For treating GDM, 64(30.5%) doctors prescribed insulin (NPH/Regular, 70/30 Mix). 112 (53.5) doctors used combination of capillary glucose by glucometer and plasma blood glucose tests for monitoring of glycemic control of patients with GDM.Conclusion:There is lack of agreed screening tests and criteria for diagnosis and management of GDM patients. Doctors need to be educated to follow evidence based diagnostic and management guidelines so that GDM patients can be effectively managed. Recently released South Asian Federation Societies and Pakistan Endocrine Society guidelines could be much needed consensus guidelines for doctors to apply in their daily practice to improve GDM diagnosis and treatment.

Highlights

Gestational diabetes mellitus (GDM) is an endocrine disorder resulting in hyperglycemia with first recognition during pregnancy affecting a significant number of pregnancies each year.[1]
Our study shows there is clear lack of consensus among health care providers regarding management of GDM
There is a lack of agreed screening tests and criteria for diagnosis and management of GDM and health care providers are not abreast with the latest evidence based recommendations internationally

Summary

Introduction

Gestational diabetes mellitus (GDM) is an endocrine disorder resulting in hyperglycemia with first recognition during pregnancy affecting a significant number of pregnancies each year.[1]. Maternal and fetal complications associated with GDM are largely preventable with early recognition and treatment.[2] In middle to low income countries like Pakistan, high maternal and neonatal mortality. The protocols used for diagnosis follow either the 75gm or the 100gm oral glucose tolerance tests (OGTT).[3] The 75gm OGTT guidance by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommends testing between 24-28 weeks of gestation in all women who have not been diagnosed with DM during the first ante-natal visit The diagnosis is established with at least two out of three elevated plasma glucose readings as follows: fasting>92mg/ dl,1-hour post 75 glucose ingestion>180mg/dl, and 2-hour post ingestion>153mg/dl.[4] The American Diabetes Association (ADA) recommendation glycemic thresholds with 75gm OGTT are similar to the IADPSG.[5] The WHO criteria (75gm OGTT) glycemic thresholds for diagnosis of GDM are the same as for a people with impaired glucose tolerance (IGT) and DM outside pregnancy.[6]

Methods

Results

Discussion

Conclusion