BIDE initiates Gestational Diabetes Mellitus Prevention and Control Programme in Pakistan

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Close collaboration between obstetricians & diabetologists planned

BIDE initiates Gestational Diabetes Mellitus
Prevention and Control Programme in Pakistan

WDF funded project to train 1620 HCPs, screen 13,000 GDM
patients at 3 GDF centers with 30 Clinics during three years period

Completion of this Pilot Project will pave the way
forĀ developing National GDM Guidelines

KARACHI: Baqai Institute of Diabetology and Endocrinology (BIDE) in collaboration with World Diabetes Federation (WDF) has initiated a pilot project for preventon and control of Gestational Diabetes Mellitus in Pakistan. This WDF funded Pilot Project will train 1620 healthcare professionals besides screening over thirteen thousand GDM patients during a three years period. Three GDM centers in Sindh province, two in Karachi and one in Hyderabad has already been identified and thirty GDM Clinics will be affiliated with these centers where they would refer the patients. After imparting training to six hundred doctors, these thirty clinics will be identified and preference will be given to those doctors who show interest in GDM care and have experience in obstetrics and gynaecology besides interest in diabetes.

Prof. Mrs. Zahida Baqai VC BMU along with Prof. Noor Jehan Samad chairing the GDM Advocacy Board
meeting at Baqai Institute of Diabetology and Endocrinology at BIDE campus on January 25th 2014.

This ambitious project is the brain child of Prof. Abdul Basit Director BIDE and pride of Pakistan in the field of diabetes. The first meeting of the GDM Advocacy Board constituted for this purpose was held at BIDE campus on January 25th which was jointly chaired by Prof. Mrs.Zahida Baqai Vice Chancellor of Baqai Medical University and Prof.Noor Jehan Samad another noted obstetrician and gynaecologist of Pakistan. It discussed various important issues related to this project. The main objective of this project is to create awareness in the community regarding GDM, to train healthcare professionals in prevention, screening, diagnosis and management of GDM, to institutionalize GDM screening and t organize integrated GDM services. Dr. Shabeen Naz Masood, Consultant Obstetrician and Gynaecologist, Medical Supdt. Of Sobraj Maternity Hospital at Karachi is actively involved in proposing and initiating this project which got approval and funding from World Diabetes Federation and it has also been supported by Baqai Medical University.
Other members of the GDM Advocacy Board who were present in the meeting included Dr. Musarrat Riaz consultant diabetologist from BIDE, Mrs.Shehla Naeem Zafar Associate Prof.of School of Nursing, DUHS Karachi, Mr.Abdul Qadir Senior Journalist from APP, Mr.Shaukat Ali Jawaid Medical Journalist Chief Editor of Pulse International, Dr. Shehla Naqvi Senior General Manager from SSGC, Mrs. Rafia Haider from APP and Dr. Asmat Nawaz from BIDE who is the Project Director. Prof. Sadaqat Jabeen Prof.of Obs. and Gynae from Hyderabad and Dr.Sobia Sabir Consultant Endocrinologist from Lady Reading Hospital Peshawar joined in the discussion through Skype.
After introductory remarks from the chairpersons Dr.Shabeen Naz Masood gave an overview of GDM.She pointed out that as per IDF Atlas 2013, there are 382 million diabetics in the world and twenty one million children were born to diabetic mothers. She then highlighted the importance and consequences of these children born to diabetic mothers which can all be prevented through high quality single intervention which can go a long way in preventing and controlling this epidemic. This is a WDF/BIDE joint project. Dr. Asmat Nawaz stated that this project which is being initiated in 2013 will be completed in three years by 2016 and we wish to create awareness about GDM in public, among healthcare professionals as well as policy makers with active collaboration and support of media.
Prof. Abdul Basit giving details of the project said that we intend to train six hundred doctors, and screen thirteen thousand women in the province of Sindh. Replying to a question, he said that to begin with the project has been confined to Sindh province due to financial and other constraints but once this pilot project is completed, it will be taken to the whole country as we did in case of diabetic foot care and Insulin My Life project. Once these projects were shown as success stories, now we have planned to establish 1700 Diabetic Foot Clinics from hundred planned in the beginning all over the country. Similarly in the beginning we had selected 34 centers for provision of free Insulin to children and now this project has been expanded with the support of community and philanthropists and donors. Similarly we hope and plan to expand this GDM project throughout Pakistan. Responding to yet another question Prof. Basit said that we have already identified three GDM centers and a few clinics and the remaining clinics will be designated taking into consideration the interest and expertise of the doctors we will be training in this project so that they can refer these patients to designated GDM centers for proper management. It was also pointed out that women wit GDM are the ideal group for primary prevention as they are at increased risk of developing Type-2 diabetes. GDM offers a unique opportunity for early therapeutic intervention with diet and exercise to delay or even possibly to prevent the onset of diabetes.
Prof. Noor Jehan Samad opined that one must first define GDM. Previously all those women who were found to be diabetic during their second half of pregnancy were labeled as GDM and those identified in first half of pregnancy were considered as Type-2 diabetes. Our experience shows that if we involve those in such projects who are interested, the results are much better. Prof. Basit said that so far there is no universal definition of GDM. The most recent definition of GDM given by IDF is hyper insulin resistance in second half of pregnancy. We have to start from some where and eventually the profession will come to a unanimously approved definition of GDM. Prof. Basit further stated that similar GDM projects funded by WDF have already been completed in India and Bangladesh with excellent results and we are trying to replicate those to promote transnational research whereby the knowledge is spread in the community. Dr. Shehla Naqvi opined that it is important to define the Key Performance Indicators (KPI) for all such projects to that they are properly monitored at regular intervals. Prof. Basit said that at present there is no universal screening method for GDM. After this project we hope to come up with Pan Pakistan strategy with reference guidelines for screening followed by diagnostic criteria for GDM and its management. Training programme for HCPs will also include midwives and paramedics involved in obstetric care. Programme also includes dietary and educational counseling, management and monitoring of identified GDM patients besides development of GDM Reference Manual.
It may be mentioned here that at present the reported prevalence of Gestational Diabetes Mellitus as per various studies is between 3.3-8% but actual prevalence could be much higher. Type-2 diabetes is now occurring at much younger age in Pakistan which also points towards increased prevalence of GDM. Complications of GDM are also reported to be much higher as compared to the developed world. The maternal complications include pre-eclampsia 19%, Polyhydramnois 4.6%, threatened abortion 3.4% while fetal complications include macrosomia 13.1%, intrauterine growth retardation 7.1% and intrauterine death which accounts for about 5.3%. Prof. Peter Baily also joined the deliberations later. Those who wish to have further information about this project can contact BIDE at This email address is being protected from spambots. You need JavaScript enabled to view it.