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

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.