Saima Askari, Musarrat Riaz, Abdul Basit.
Health Care Professionals Perspective regarding Gestational Diabetes Mellitus in Pakistan: are Clinicians on the Right Track?.
Pak J Med Res Jan ;58(3):127-33.

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. Post-partum 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.

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