International Update On Gestational Diabetes Mellitus

NEW MODEL OF CARE FOR GESTATIONAL DIABETES IMPROVES HEALTH OF MOTHER AND CHILD

MDRF, IDF and Abbott Fund share results of new WINGS programme to help address the hidden epidemic of gestational diabetes in India

Chennai, India- September 25, 2015:  India is one of the diabetes capitals of the world, and has among the highest rates of women with Gestational Diabetes Mellitus (GDM), with more than 5 million women affected in the country each year. A new response to the epidemic in India was announced at a press meet at Chennai today, with global diabetes experts sharing results from an innovative partnership between the International Diabetes Federation (IDF), Madras Diabetes Research Foundation (MDRF) and the Abbott Fund, the philanthropic foundation of the global healthcare company Abbott. 

The new GDM Model of Care [http://www.idf.org/women-india-gdm-strategy-wings] is part of the WINGS (Women in India with GDM Strategy) programme, a collaboration between IDF, MDRF and supported by an unrestricted grant from the Abbott Fund. The programme provides community based interventions for women with GDM in low resource settings and was piloted in Tamil Nadu in India involving more than 2,100 women.  More than 60 physicians were trained on the model of care, and more than 250 community health workers were involved in the outreach programme to raise awareness of GDM. The project focused on the importance of close follow up and interaction between healthcare workers and patients. 

Results of the Wings Programme

After implementation of the Model of Care, women with GDM were found to have pregnancy outcomes similar to the pregnant women without GDM, i.e. the general population of Tamil Nadu. Most of the adverse outcomes of GDM, for example obstructed labour, were prevented.

Importantly, the project also saw 96% of women return for follow-up after delivery; a record of sorts in India where post-partum follow up rates are usually between 10 to 20%. At the 6 weeks follow up testing, 4% women had already developed type 2 diabetes. This emphasizes the need for immediate follow up check for diabetes after the delivery. 

The WINGS project demonstrated that through an intensive and continued effort, universal post-partum follow up is achievable, thereby creating an opportunity for prevention of type 2 diabetes. It also demonstrates that following a structured model of care, pregnancy outcomes in GDM women can be improved to the level seen in women with no diabetes. 

Dr.V.Mohan, Director of Madras Diabetes Research Foundation said that “the WINGS project has helped local women manage GDM and raise awareness about GDM in Tamil Nadu”.and to train medical and paramedical personnel in GDM. 

“With WINGS we have the unique opportunity to improve the lives of two generations and prevent type 2 diabetes in mothers” said Ms Anne Belton, Vice-President, IDF “this is good news for Indian social and economic development, which will set the example for other low resource settings”. 

“Gestational diabetes is a hidden epidemic. It affects more than 5 million pregnant women each year in India, but they often don't know it, which leads to increased risks for themselves and their babies," said Andy Wilson, Vice President, the Abbott Fund. "The WINGS programme provides mothers with the information and support they need to take charge of their own health, and the health of their children – creating healthier futures for families across India.” 

GDM and Diabetes in India

India has over 5 million women with GDM each year, many of whom 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. 

More about the Model of Care

The WINGS GDM Model of Care was developed using best practice of care and established clinical guidelines.  This was done in conjunction with practitioners from the

collaborating sites (urban and rural health facilities) in Chennai, India to ensure that the approach is culturally appropriate and feasible. WINGS aimed to respond to some of the

critical gaps pertaining to GDM care, in a low-resource context, in accordance with the recommendations outlined in the IDF Global Call to Action and Policy Brief on Diabetes in Pregnancy. The Model of Care has the following components: 

1. Testing of all pregnant women for GDM: The WINGS project recommends testing to be done – preferably at the first visit to the antenatal clinic to rule out preventing diabetes and doing fasting oral glucose tolerance test (OGTT) at 24 – 28 weeks.  Screening all pregnant women is a critical first step to providing them with the care and guidance to help them stay healthy.

2. Providing women with GDM, education and guidance on a balanced diet (richer in protein), exercise (a minimum of 30 minutes of exercise a day) and appropriate medical care. 

3. Engaging and mobilizing health care providers and the broader community on the prevention and care of GDM.

4. Following up women with GDM, treated through the model of care, which uses a structured treatment program with defined blood sugar values and other criteria, to ensure safe delivery

5. Following up women with GDM after delivery, to look at pregnancy outcomes and to check for diabetes status at 6 weeks post-delivery.

International Update on Gestational Diabetes Mellitus

An International Update on Gestational Diabetes Mellitus to showcase the learnings from the WINGS project, is being organized at Chennai on the 26th and 27th of September 2015. The Update brings together the world's experts in Gestational Diabetes from different parts of the world, including the world renowned Dr. Donald Coustan, considered the ‘Father of Gestational Diabetes’, who will be representing the American Diabetes Association. There will also be representatives of several other national and international societies. Over 300 delegates representing physicians, obstetricians and gynaecologists are expected to attend the International Update on GDM.  

The update will be inaugurated by Dr. J. Radhakrishnan, Secretary to Government, Health and Family Welfare Department, Govt of Tamil Nadu, and several other Govt. officials will be participating in the inaugural function  on 

26th September 2015 at 11 am.  The “WINGS Educational Tool Kit” will be released during the inaugural ceremony and Prof. V. Seshiah will be conferred the DMDSC Lifetime Achievement Award. 

Going forward, MDRF and IDF will aim to involve the Indian Government in the implementation of this model of care in other Indian states through partnership with key organizations. The Public Health Foundation of India (PHFI) will help to disseminate findings of the WINGS project through their Certificate Course in Gestational Diabetes Mellitus (CCGDM) which is done in collaboration with Dr.Mohan’s Diabetes Education Academy (DMDEA). In the longer term the WINGS model will be rolled out across similar low resource settings in other countries.

Global healthcare professionals will also be introduced to the Model of Care this December at the IDF World Diabetes Congress to be held at Vancouver, Canada, in December 2015.