Screening for gestational diabetes in the United Kingdom: a national survey

A community health worker-led program to improve access to gestational diabetes screening in urban slums of Pune, India: Results from a mixed methods study

The World Health Organization recommends all pregnant women receive screening for gestational diabetes (GDM) with a fasting oral glucose tolerance test (OGTT). However, very few women receive recommended screening in resource-limited countries like India. We implemented a community health worker (CHW)-delivered program to evaluate if home-based, CHW-delivered OGTT would increase GDM screening in a low-resource setting. We conducted a mixed methods study in two urban slum communities in Pune, India. CHWs were trained to deliver home-based, point-of-care fasting OGTT to women in their third trimester of pregnancy. The primary outcome was uptake of CHW-delivered OGTT. Secondary outcomes included GDM prevalence and linkage to GDM care. Individual interviews were conducted with purposively sampled pregnant women, CHWs, and local clinicians to assess barriers and facilitators of this approach. From October 2021-June 2022, 248 eligible pregnant women were identified. Of these, 223 (90%) accepted CHW-delivered OGTT and 31 (14%) were diagnosed with GDM. Thirty (97%) women diagnosed with GDM subsequently sought GDM care; only 10 (33%) received lifestyle counseling or pharmacologic therapy. Qualitative interviews indicated that CHW-delivered testing was considered highly acceptable as home-based testing saved time and was more convenient than clinic-based testing. Inconsistent clinical management of GDM was attributed to providers' lack of time to deliver counseling, and perceptions that low-income populations are not at risk for GDM. Convenience and trust in a CHW-delivered GDM screening program resulted in high access to gold-standard OGTT screening and identification of a high GDM prevalence among pregnant women in two urban slum communities. Appropriate linkage to care was limited by clinician time constraints and misperceptions of GDM risk. CHW-delivered GDM screening and counseling may improve health education and access to preventive healthcare, offloading busy public clinics in high-need, low-resource settings.

Emerging and Public Health Challenges Existing in Gestational Diabetes Mellitus and Diabetes in Pregnancy

We review the evidence available worldwide on the various challenges in the screening, management, prevention of gestational diabetes mellitus and diabetes in pregnancy. The use of multiple screening and diagnostic tests prescribed by numerous guidelines is challenging for practitioners. Also, sociocultural, demographic and economic challenges affect the prevention and care. Life-course perspectives need to be adopted, as well as an integrated approach in public health care is essential. Tackling these challenges at each phase of life-course, with development and adherence to the country-specific guidelines by practitioners can decrease the burden of gestational diabetes mellitus and diabetes in pregnancy.

Management of gestational diabetes by physicians in Turkey

AIMS

We sought to investigate the practice patterns of clinicians (family physicians, internists and obstetricians) in Turkey in screening for gestational diabetes mellitus (GDM), management and monitoring of hyperglycaemia in pregnant women with GDM, and assessment of glucose tolerance in the postpartum state.

METHODS

Between January and December 2007, current practices of Turkish physicians (n=434) were assessed by a questionnaire which was concerned with physician demographics and clinical practice including screening and diagnostic methods for GDM, management of GDM during pregnancy and postpartum assessment of glucose tolerance. The questionnaire was developed in respect to the recommendation of the Fifth International Workshop-Conference on GDM and the standards of the American Diabetes Association (ADA).

RESULTS

Although most of the physicians stated that they performed screening for GDM and postpartum screening for glucose intolerance in women with GDM, their screening practices vary. The proportion of women who were provided with a nutrition counselling by a registered dietician and a patient education by a trained nurse was low, especially in women treated by the family physicians. Home glucose monitoring was widely used in the management of GDM, however, postprandial glucose assays were used occasionally. Regular and NPH insulin preparations were the most preferred drugs to treat GDM. Internists were more likely to use insulin analogues. On the other hand, a significant number of physicians stated that they used oral antidiabetics (OADs). A considerable number of family physicians used OADs which have not been proved to be safe in pregnancy.

CONCLUSIONS

Our results suggest that there is considerable variation in the clinical practice patterns of physicians. An education program to enhance the clinical aptitude of physicians, particularly family physicians, in the medical management of GDM should be designed throughout the country.