Health Care Professionals Perspective Regarding Gestational Diabetes Mellitus in Pakistan: Are Clinicians on the Right Track?

Abstract

Objective: To study health care professionals’ perspective working at tertiary care settings regarding gestational diabetes mellitus (GDM) and to recognize differences in the practice and approach amongst them.
Study type, settings and duration: A cross-sectional survey was carried out at several tertiary care hospitals of all four provinces (Punjab, Sindh, Baluchistan and Khyber Pakhtunkhwa) from January 2017 to December 2018.
Methodology: A Nationwide cross-sectional survey on the practice patterns with respect to screening, diagnosis, management and follow-up of Gestational Diabetes Mellitus was carried out at several tertiary care hospitals of Pakistan covering physicians/ diabetologists/ endocrinologists and Obstetrician/ gynecologists. Health care professionals from public and private sectors were invited to participate. Total 300 health care professionals (HCPs) participated in this survey
Results: Among the survey participants 49.8% were general physicians, 37.8% were gynecologist/obstetrician while 12.4% were diabetologist/ endocrinologist. Regarding screening methods used by HCPs, 75gm oral glucose tolerance test (OGTT) was used by 20.4%, 50-gram glucose challenge test (GCT) by 18%, and 100- gram OGTT by 1% . A large proportion of study participants (40.4%) were using fasting blood glucose/random blood glucose for the diagnosis of GDM while 75gm OGTT for the diagnosis of GDM were practiced by only 25.1%, followed by 50gm GCT by 20%, urine glucose by 8%, HbA1c by 5.2% and 100 gm OGTT by 1.3%. While 97% advised self-monitoring of blood glucose level. Out of them 55.8% advised self-monitoring of blood glucose daily, 24.6% weekly while 19.6% monthly. Most common regimen prescribed by HCPs for management of GDM included life style modification (LSM) plus metformin plus insulin in 38.8% study participants. Postpartum screening for persistence of diabetes was advised by 80.4% HCPs. Investigations done for follow up of GDM through FBS/RBS by 50%, HbA1c by 25.3%, OGTT by 19.5% and multiple tests used by 5.2%.
Conclusion: The present study reveals that there are major differences amongst health care professionals regarding various aspects of GDM management.