Khyber Medical University Journal (Mar 2023)
MANAGEMENT OF GESTATIONAL DIABETES MELLITUS: AN INSIGHT INTO EVIDENCE-BASED PRACTICE AMONG POSTGRADUATE TRAINEES OF OBSTETRICS AND MEDICINE DISCIPLINES
Abstract
OBJECTIVE: To explore the discrepancies regarding screening, diagnosis & management of gestational diabetes mellitus (GDM) among postgraduate trainees of Obstetrics & Gynaecology (OBG) and Medicine disciplines. METHODS: This multicentre cross-sectional study was conducted from 1st to 31st August 2022. The questionnaire regarding screening, diagnosis, management of GDM, & postnatal follow-up with neonatal care were distributed among postgraduate trainees of medicine/OBG through google-form/hardcopies. Data was analysed through SPSS-22 RESULTS: Out of 236 trainees, 184 (78%) were following national institute of clinical excellence (NICE) guidelines for management of GDM. Majority of medicine (n=87/120 (72.5%) & OBG (n=76/116; 65.5%) trainees failed to identify the correct cut-off of oral glucose tolerance test for GDM. A big chunk of both OBG (n=93/116; 80.2%) & Medicine (n=96/120; 80%) trainees were unable to differentiate pre-existing diabetes mellitus from GDM. The clinical knowledge about carbohydrate diet (n=119/236; 50.4%), calories intake (103/236; 43.6%) & low glycaemic index (138/236; 58.5%) was poor among trainees of both specialities. Surprisingly, the medicine trainee’s knowledge about insulin types, dose & tocolytic agent was not evidence-based. The practicing knowledge of both specialities was poor about identification of neonatal hypoglycemia (n=30/236; 12.7%) & its management (n=47; 19.9%). Trainees of both specialities had poor knowledge about postnatal follow-up (n=64/236; 27.1%) of GDM patients. CONCLUSION: GDM is a common domain for OBG & medicine disciplines with no consensus guidelines for its uniform management. This study has identified some basic gaps in the clinical practice of future consultants regarding GDM management, urging the need of combined local guidelines.
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