Addressing the challenges of GDM detection and management in low resources-settings: a pilot project implemented by IDF in Chennai/India
Gestational diabetes mellitus (GDM) is a severe and neglected threat to maternal and child health. India is one of the diabetes capitals of the world, and has among the highest rates of women with GDM, with more than 5 million women affected in the country each year.
Many women with GDM experience pregnancy related complications including high blood pressure, large birth weight babies and obstructed labour. A significant number of women with GDM also go on to develop type 2 diabetes resulting in further healthcare complications and costs. At 66 million, India currently has the second highest number of people with type 2 diabetes in the world; almost half of these cases are women.
The Women in India with GDM Strategy (WINGS) project is the first-ever strategy to tackle the rising prevalence of GDM in India. This project aimed to develop a context-adapted model approach to care in low-resource settings which confronts the widespread challenges in GDM screening and management. The project developed a standardised approach to GDM care, seeking to improve the health outcomes of women with GDM and their new-borns, strengthening the capacity of selected health facilities to address GDM. This included developing additional materials for health outreach workers.
The resulting IDF GDM Model of Care will be piloted in India, and subsequently adapted to be scaled-up in other low- and middle-income countries worldwide.
The project is led by the International Diabetes Federation (IDF) in partnership with the Madras Diabetes Research Foundation (MDRF). Seven rural and urban collaborating health centres were identified in Tamil Nadu State (South India). An Expert Committee was set up to advise the project implementation according to a two-step process: (1) to develop a curriculum and accompanying tools to train healthcare professionals (HCPs) and women on GDM screening and management (multidisciplinary target group of physicians, diabetologists, dieticians, nurses) and (2) to develop a context-specific model of care for GDM (that incorporates the curriculum).
Situation analysis 2013
In order to establish a strong and comparative baseline, a comprehensive situation analysis was first conducted to identify the current state-of-the-art, gaps and barriers to care for women with GDM which must urgently be addressed by the model of care. This was comprised of a literature review, an online survey of health practitioners, knowledge attitude and practice surveys (KAP) of women and rural health workers, medical records review, and pilot screening.
The situation analysis was completed in March 2013 and shaped the subsequent progress of the project. A summary of current practices relating to screening and diagnosis in the literature review permits WINGS to build on positive aspects of current knowledge and practice. The physician survey confirmed the suspected lack of uniformity concerning the point at which screening is performed and the criteria for GDM diagnosis, with four different sets of guidelines all being widely used (by ≥18.0% respondents) even within India alone.
At present, there are no universal validated guidelines for GDM care, many constraints in low- and middle-income countries, and consequently a lack of clear direction for health practitioners (showing the relevance of the WINGS project). This presents a formidable barrier to ensuring appropriate diagnosis and cost-effective patient management, leading to less-than-optimal care and poor patient outcomes. The WINGS project will serve to permit development of a model of care which is both effective and feasible for implementation in resource-constrained settings, being based on global aspects of best practice and detailed research into local conditions.
In conclusion, the WINGS project will develop a multidisciplinary approach to screening and managing GDM in India, that can be integrated into the existing package of maternal and child health services and can thereafter be adapted for other low-resource settings. The implementation process and the impact of the project’s interventions will be measured and the results diffused.
The WINGS project has been developed through a partnership between the International Diabetes Federation (IDF), the Madras Diabetes Research Foundation (MDRF) in Chennai, India, and the Abbott Fund, the philanthropic foundation of the global healthcare company Abbott.