Capacity Building for Prevention of Complication from Gestational Diabetes in Public health system, UP Dr Rajesh Jain Project Manager Diabetes Prevention Control Project ,National Health Mission,Uttar Pradesh

National Guidelines for GDM - Diagnosis & Management

After 2 weeks on MNT, a 2 hrs PPPG (post meal) should be done Universal testing for GDM Thus, GDM is managed initially with MNT and if it is not controlled with MNT, insulin therapy is added to the MNT

Post Partum Screening -Post Partum Screening for Diabetes after 6 weeks of delivery to be done in Immunization clinic or MCH clinic, both the facility link through training of staff,this is mandatory for GDM,Post Prandial Blood sugar is to be done and diagnosed Type II Diabetes if blood sugar >=200 mg/dl and treated for Type II diabetes in NCD clinic. Post Partum follow up of Pregnant Women with GDM:  Immediate postpartum care women with GDM is not different from women without GDM but these women are at high risk to develop Type 2 Diabetes mellitus in future.  Maternal glucose levels usually return to normal after delivery. Nevertheless, a FPG & 2 hr PPPG is performed on the 3rd day of delivery at the place of delivery. For this reason, GDM cases are not discharged after 48 hours unlike other normal PNC cases.. Subsequently, ANM to perform 75 g GTT at 6 weeks postpartum to evaluate glycemic status of woman.

Cut offs for normal blood glucose values are:  l. Fasting plasma glucose: ≥ 126 mg/dl lI. 75 g OGTT 2 hour plasma glucose III. Normal: < 140 mg/dl IV. IGT: 140-199mg/dl V. Type II Diabetes: ≥ 200 mg/dl VI. Test normal: Woman is counselled about lifestyle modifications, weight monitoring & exercise. VII. Test positive: Woman advised to consult a physician/NCD Clinic. VIII. PW with GDM and their offsprings are at increased risk of developing. Type II Diabetes mellitus in later life. They should be counselled for healthy lifestyle and behaviour, particularly role of diet & exercise. IX.GDM should be a part of NCD (Non communicable Disease) programme.

Gestational Diabetes Uttar Pradesh 28 Districts to be covered under NPCDCS,NHM District Hospital/CHC/PHCs to be Covered Training Criteria any hospital where more>200 Deliveries in a month 1236 PHC/CHC/DH Facilities for GDM Diagnosis & Management by March 2019 3000 Doctors and 6000 Nurse/Paramedical staff to be covered in next 3 years in two full day Certified Training Syllabus as per IDF and NHM GOI Guidelines

One Million Pregnant Screening by March 2019 Screening All Pregnant Women all trimester in 1236 health facilities. All Districts to be covered in UP after Sept,2017. Largest GDM outcome & Prevalence study in World. Two OGTT test During Pregnancy & Postpartum screening after 6 Wks of Delivery Mandatory. Provision of Insulin at All centres and Inclusion of Metformin for Management of GDM.

Gestational Diabetes Outcome Evidence in Uttar Pradesh Gestational Diabetes Prevalence and Outcome Study in Uttar Pradesh Screening All Pregnant Women Population based Study in 198 ANC Centres at Kanpur Nagar. 57,000 Pregnant Women covered through Single OGTT Test in 24-28 Wks of Gestation Overall Prevalence 14.6% in Population based Study.

List of standard medical and laboratory equipment forPregnancy & Diabetes clinics For the clinics: At primary care level Medical equipment: Stethoscope Weigh scale Height measure Measuring tape Sphygmomanometer + appropriate size cuffs   Laboratory equipment: Glucometer + appropriate strips Urine strips for glucose, ketones, proteins. At secondary care level ECG

Laboratory equipment: Urine strips for glucose, ketones and proteins. Equipment for HbA1c measurements. Equipment for OGTT: D-Glucose Glucometers + appropriate strips Biochemistry analyser for: Blood glucose Assessments of renal function and lipids..   At tertiary care level Medical equipment: Stethoscope Weigh scale Height measure

Sphygmomanometer + appropriate size cuffs ECG Laboratory equipment: Measuring tape Sphygmomanometer + appropriate size cuffs ECG Laboratory equipment: Urine strips for glucose, ketones and proteins. Equipment for HbA1c measurements. Equipment for OGTT: D-Glucose Glucometers + appropriate strips Biochemistry analyser for: Blood glucose Assessments of renal function and lipids Advanced equipment for: Renal clearance Microbiology.   For people with diabetes during pregnancy: At all care levels (primary, secondary and tertiary) Equipment for home blood glucose monitoring: Glucometers Appropriate blood glucose strips Urine strips for ketones