The project seeks to create awareness among the public - in particular women's groups - on gestational diabetes mellitus (GDM) and to build capacity in the health care system to prevent, manage and control the problem.
Expected Impact
An estimated 2,450 health care staff, including doctors, nurses, dieticians and extension educators will be trained directly or indirectly on symptoms, treatment and preventive/control measures
Automatic screening for gestational diabetes among pregnant women will become institutionalised in the target areas
An estimated 400 women with gestational diabetes will be treated and taught how to prevent subsequent type 2 diabetes for themselves as well as their families
2100 women at risk of gestational diabetes will be taught how to prevent subsequent diabetes for themselves as well as their families
Results to date
A total of 12,056 have been screened for gestational diabetes, diagnosing 1,679 women (13.9%). In the rural area of Tiruvallur the prevalence rate was 9.9%; in the semi-urban district of Saidapet Taluk it was 13.8% and in urban Chennai it was 17.8%.
All 1,679 women diagnosed with gestational diabetes were treated with meal plan to maintain their target blood glucose levels. They were periodically followed up every month and those women who did not achieve control with meal plan alone, were advised insulin.
Among 8,731 women who were followed up upon, the incidence of birth weight abnormalities was reduced significantly in comparison to the National Health Survey (19% macrosomic babies nationally compared to 7% among the women in the project).
In March 2007, the Tamil Nadu Government issued an order making screening for gestational diabetes during pregnancy mandatory.
Awareness has been created among the public, particularly women groups, medical, para medical, non-medical and public health professionals on the implications of abnormal glucose tolerance during pregnancy and about the preventive and control measures to be followed.
Health care personnel has been involved in maternal and child health care in the diagnostic procedures of screening, diagnosis and proper management of gestational diabetes using appropriate simple cost effective techniques.
A surveillance system has been established by estimating the prevalence of gestational diabetes in the project area and establishing a registry to determine the incidence rate of gestational diabetes among pregnant mothers.
Public health staff has been trained to communicate and disseminate preventive behavioral lifestyle changes to the target population and community at large.
In addition to the 32 million people living with diabetes in India, recent data indicate that about 16% of pregnant Indian women have gestational diabetes.
Despite medical and scientific advancement many remain in the dark about basic knowledge on diabetes and its prevention and control measures - not least information and awareness on gestational diabetes mellitus.
This is true not only for the lay public but also among health care professionals. The problem of gestational diabetes and its potential influence on the development of diabetes in the mother and child at a later stage has been largely un-addressed.
Approach
The first three years of intervention are considered a pilot phase of the project. In this phase, the project will focus on one urban and one rural setting. These will be the city of Chennai and Kanchipuram district in the state of Tamil Nadu.
The surveillance aspect of the project covers 1000 pregnant women in Chennai city and 1500 in Kanchipuram district attending primary health centres and child welfare centres spread over the selected areas. These women will form the primary target group to be followed for a period of three years.
Capacity building will take place at different levels. Medical professionals in the project area will be trained for monitoring and guiding the field staff to run the project activities.
The field staff will be trained to be able to perform the various activities, including enlisting pregnant women, administering glucose tolerance test, identifying gestational diabetes, medical nutrition therapy, insulin administration, follow up etc.
Last but not least, local NGO's women self help groups are trained for their effective participation to educate their families, other women and the communities at large.
The awareness component of the project will focus on first identifying message contents for dissemination among the target groups. Production and distribution of posters, handbills, pamphlets and stickers will take place and mass media will be used to disseminate the messages.
Specialist agencies will be used for the mass media aspect, whereas local NGOs play a key role in raising the awareness in the communities.
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