Battling the rising prevalence of gestational diabetes in India: Are clinicians on the right track?

Abstract

Background: Gestational diabetes (GDM) is associated with increased long term problems of type 2 diabetes in the mother. In the offspring, GDM can append an intrauterine environmental risk factor to the increased genetic risk for the development of childhood obesity and/or type two early adult onset diabetes. Given the high prevalence of GDM in India, there is a real threat of an epidemic of type 2 diabetes in INDIA. Objective: (a) To assess knowledge among obstetricians in India, regarding management of GDM with respect to strict glycemic monitoring to provide the right environment to the fetus and timely intervention. (b) To assess the attitudes and practices with respect to long term follow up of the mother. Materials and methods: A 25-question online survey (www.abcofobg.com) was developed to assess providers' knowledge, practices and attitudes related to the management of GDM. The final sample consisted of 584 respondents. Data were analyzed using SPSS version 16.0. Results: When patients were on insulin, 41% of the clinicians did not insist on daily home monitoring using a glucometer. They resorted to estimation of post breakfast blood glucose at two-week intervals. Only 60% had access to endocrinologists for advice regarding insulin dosage adjustments. Only 35.71% of the clinicians said to wait for spontaneous labor. 64.29% of doctors said they would intervene and deliver at 38 weeks. Out of 584 respondents, 70.24% were aware of long term complication of childhood obesity and adult onset diabetes. Majority of doctors (92.86%) knew that T2DM was the long-term complication in GDM mother and 67.86% were aware of possibility of GDM in next pregnancy. Only 17% of clinicians offered WHO 75 gm testing for sugar estimation at the six weeks postpartum visit and 70% of the practitioners advised regarding exercises and diet. Conclusions: This study raises the challenge of how to translate the evidence from well-resourced research studies into initiatives that are affordable and feasible, whether in richer or poorer parts of the world. Also, the study results reveal the urgent need to improve the quality of diabetes treatment and care: accessible, community-based, multi-disciplinary teams, and patient-centered approach.