Gestational Diabetes Prevention Control Project-Kanpur Nagar,Project Report:April-2013 to 15 Sept-2013.

Implementation by Jain hospital Mahavir Sikshan Sansthan

1.Project Management Assessment from Oct,2012 to Sept,2013.

♦   -198 Reporting Health facilities Where OGTT 75 gm Glucose test by Glucometer is being performed(Where Gyanecologist is available) were established,100 in Private Hospitals & 50 in Govt health facility including CHCs(Community Health center),PHCs(Primary health Center),UHP(Urban health Post),Dtype center,UFWC(Urban family Welfare Centres) centers,New PHCs(New Primary health Centers),District hospitals others 4 major hospitals in Public sector.

♦   -232 Screening Camps for GDM were conducted in field and Reporting units.These are ANC (Antenatal Check UP Camps) with Gyanecologist in Rural,slums,Semiurban Areas were organised.15762 Pregnant Women attended these camps given free Consultation by Gyanecologist,4763 Women Between 24-28 Weeks of Gestation gone through 2hr OGTT with 75 gm Glucose,out of that 465 were Diagnosed as GDM.They were women from Lower Social economic section of Society(BPL) in these camps.

♦   -Data Collection software was procured as per our need and functional.

♦   We have two annexure I & II,Annexure I is for Screening where we try to collect data on Screening Pregnant women on Name,address,Weeks of Gestation,Parity,Gravida,Weight,Height,BMI,Blood Pressure,Diet total calories,Income of family,Education level,Still birth in past,History of Diabetes in family,History of Blood sugar screening,H/o PIH,Urine Albumin.

♦   OGTT 2hr with 75 Glucose,blood sugar with Glucometer measured as plasma level.

♦   Annexure II for diagnised with GDM where we record status of GDM,name,weight,height,BMI,waist circumference,BP,hist of diabetes before pregnancy,H/o blood sugar screening,H/O Hypertension.Blood Sugar 2 hr OGTT values on two Follow up dates after 2 weeks and advice on diet,Exercise.Although all the Screening hospitals and Reporting Units are not filling up all the informations provided in Annexure I and II.

♦   -18556 Pregnant Women were screened in 198 Reporting health Units & 232 Screening Camps, out of total 18556 screening,4763 were during Camps,out of (18556) them 2517 women were diagnosed as GDM (Prevalence Rate 14%)with OGTT 2hr 75 gm Glucose test >140 mg% as per DIPSI Guidelines irrespective of last meal.Performa Glucometer(Roche) were used,75 gm Glucose Packets were prepared in our own center and distributed along with Glucometers(Achucheck performa,these meters were caliberated for value of plasma blood sugar level) and strips,lancets,glass,spoon etc.to all 198 Reporting health Facilities.Out of 2517 women Diagnosed with GDM They received Diet Counselling and a Diet chart in hindi local language with total calories according to weight from our Reporting health facilities.

♦   Out of 2517 diagnosed GDM, 2176 were given at least one follow up and 30 again tested for Post Partuml blood Glucose.

♦   Post Partum follow up was very difficult we have very limited data from Reporting Units,at present 10 hospital are keeping data on Follow Up postpartum,We are trying to stress hospitals for OGTT postpartum screening in GDM Women whenever she comes after delivery or 6 weeks to detect type II diabetes and Document this.

♦   -Training Materials for Doctors & Paramedical Staff was prepared in consultation with IDF 2011 Education Module and GDM in pregnacy IDF Guidelines.DIPSI Guidelines has been followed in our Modules.

♦   -TOT was organised in 2 sessions involving 5 Master trainers including 3 Gyanecologist one Diabetologist and Communication Expert. 16 Gyanecologist were trained in 3 days training all the aspect of GDM and Diabetes were covered like use of insulin,oral drugs etc.

♦   FOGSI Secretary,President were involved as master Trainers.

♦   -Training of 612 Doctors were completed in 2 sessions including 163 doctors from Govt health system and 449 Doctors from Private sectors mainly Physician,Primary care physicians,Gynecologist were involved.

♦   Training was attended by Gyanecologist DGO,MS, MBBS Obstericians and BAMS,BHMS Participants.

♦   -Training of 1678 Paramedical Staff including Nurses,ASHAs were completed through 4 sessions including 462 Private Nurse and 1216 Govt ASHA's(Accrediated Social health Worker under NRHM),ANM(Auxillary Nurse Midwife) and GNMs(General Nurse Midwife.

♦   20 Questions test was also taken at the end and most were able to pass.

♦   -One state level workshop was organise in lucknow in the prescence of Mr Freddy Svane ambassdor of denmark and chief Justice Mr Sudhir Saxena as chief Guest of event.

♦   Workshop was attended by Gyanecologist,Doctors,NGOs,Social organizations,Cabinet Ministers from Govt and health officials from Govt.

♦   -4 districts Workshop was conducted,two at CMO(Chief Medical officer) office auditorium where 60 MOICs,health Incharge of all the Govt Faciities were present,3 sessions of lectures and deliberations were given by Project manager,Gyanecologist and ACMO(NRHM).

♦   Workshop were also attended by ACMO Immunization,ACMO NRHM,ACMO Family welfare,Unicef Coordinator,WHOs SMO.

♦   One District Workshop was Completed with FOGSI & Its Members Gyanecologist.

♦   Other Workshop was organised with Media houses of 30 major newspaper and Channels.

♦   Media was sensitised about GDM and Growing Epidemic of Diabetes.Event was covered in newspers.

♦    -GDM hotline has been established and Calls related to Diabetes in pregnancy and those diagnosed with GDM were counselled around 2500 women received counselling related to Diet and physical exercise,use of insulin etc.

♦   Outcome Data.

A.    Maternal and foetal outcome in GDM.
B.    PIH:126 (N=2456) 5.1%
C.    Family H/O Diabetes:53(N:546) 9%
D.    H/o IUD/Miscarriage:12(546)>
E.    Malformations=14(546)
F.    Post Partum Screening:30(546)5%
G.    Diagnosed Diabetes:Tt not taken 92 (N=546) 20%
H.    H/O Tt taken for Infertility=108 (N=546) 20%
I.    Insulin use=26(N=546)5%
J.    Neonatal Mortality:12(546)45/1000
K.    Maternal Mortality:2.



Our Partners & Collaborating agencies/Govt/NGOs/Private Organization with MAHAVIR SIKSHAN SANSTHAN

A.    PHED Department, govt. of Bihar

B.    Sarwa Siksha Abhiyan, Jamui, Bihar

C.    W.H.O. Polio eradication Lakhisharai & Jamui, Bihar.

D.    "Janani Suraksha Yojna" under NRHM(National Rural health Mission) in Kanpur since 2007.

E.    Ministry of textiles, Govt. of India.

F.    "Prayas"with Sanofi-Aventis Pharma 24 CME for MBBS,BAMS Doctors in Rural area of Kanpur pharmaceutical since 2007.

G.    "Hypoglycemia Prevention Derive" 10 CME with MSD since 2009.

H.    Sudden cardiac death & its Management 12 CME for Prim care Doctors with Abbotts.

I.    SAMBHAV voucher scheme for pregnant women with USAID (SIFPSA) since 2008.

J.    Mary Gold hospital network camps in Slums for antenatal mothers with HLPPT since 2009.

K.    RSBY (Rashtriya Swasthya Bima Yojna) Medical Insurance scheme for BPL since 2008.

L.    Diabetes Awareness and Control camps with Rotary International since 2008

M.    Media Sensitization workshop in Diabetes and Hypertension with PCI(Press club of India).

N.    Media poster for diabetes in Hindi with IDF(International Diabetes foundation) in 2011 and 2012.

O.    Diabetes & Hypertension Camps with Bayer, Abbotts, Cipla, Astra Zeneca, MSD, USV, Novo-Nordisk, Boehringer-lilly, Sanofi-aventis, Serdia since 2006

P.    "Gestational Diabetes Prevention & Control Project" in Collaboration with Ministry of health & Family welfare, GO-UP Supported by World Diabetes Foundation(WDF) since June,2012

Q.    Ministry of Health & Family Welfare Govt of Uttar Pradesh

R.    World health organization in Routine Immunization & Measles Control.



3.Project Material Developed:


-IDF Module 2012 -2 Training sessions of Doctors.

-4 training sessions for Paramedical.

-DIPSI Guidelines,others guideines.

-200 Reporting health facilities is shown as H in red in Kanpur Map

-IEC Materials for Camps,Reporting units,Rally,Global Diabetes walk

Papers cutting of Gestational Diabetes Prev control project kanpur Nagar.

-Photos of Training Sessions,workshops,Media workshops,State workshops,camps,kanpur Global diabetes walk 2012.

–More than 30 Article on GDM were Published in Hindi Newspaper ,Media Coverage of Camps on GDM .

Collaboration with Uttar Pradesh Major Media Umar Ujala was signed for 3 Major Follow UP Mega camps on Antenatal Mothers with free OGTT & other test on 50% concession.

  • Jain Hospital

    108-B Gandhi Gram Vinobha Nagar
    Near Malik Guest House
    Ramadevi Kanpur,

  • Phone: +0512-6554370
    Mobile No: 9838533670
    Regd.No: 039790




Diagnosis and Management of Gestational Diabetes Mellitus: Indian Guidelines

Seshiah V, Sahay BK, Das AK, Balaji V, Siddharth Shah, Samar Banerjee, A Muruganathan, Rao PV, Ammini A, Shahsank R Joshi, Sunil Gupta, Sanjay Gupte, Hema Divakar, Sujata Misra, Uday Thanawala, Vitull K Gupta, Navneet Magon

INTRODUCTION

"Gestational diabetes mellitus" (GDM) is defined as carbohydrate intolerance with onset or recognition during pregnancy. Women diagnosed to have GDM are at increased risk of future diabetes predominantly type 2 diabetes mellitus (DM) as are their children. Thus, GDM offers an important opportunity for the development, testing and implementation of clinical strategies for diabetes prevention.

EPIDEMIOLOGY

The prevalence of GDM in India varied from 3.8 to 21% in different parts of the country, depending on the geographical locations and diagnostic methods used.

SCREENING AND DIAGNOSIS

Compared to selective screening, universal screening for GDM detects more cases and improves maternal and neonatal prognosis.

World Health Organization Procedure

To standardize the diagnosis of GDM, the World Health Organization (WHO) recommends using a 2-hour 75 g oral glucose tolerance test (OGTT) with a threshold plasma glucose concentration of greater than 140 mg/dL at 2 hours, similar to that of IGT (> 140 mg/dL and < 199 mg/dL), outside pregnancy.

American Diabetes Association Procedure

American Diabetes Association (ADA) procedure has become obsolete.