Prediabetes and cardiovascular complications study: Highlights on gestational diabetes, self-management and primary health care

Abstract

International collaboration on the prediabetes and cardiovascular complications study started in 2013. In 2017, a reflection was reported. Incompleteness of documentation and screening of antenatal cases for gestational diabetes mellitus (GDM) was concerning. Hence, further observations have been made that warrant an update. The objective of this review is to highlight gaps between clinical knowledge and practice in GDM, diabetes self-management and primary health care (PHC) for rural dwellers. We followed a descriptive field notes method. Antenatal records of patients screened for GDM with incomplete documentation were examined to determine incompleteness of data in those that also met the criteria for GDM risk assessment. Experiences on development of a diabetes register and education and notes on behavioural change wheel were also reviewed. Other data included cross-sectional evaluation of activities of daily living at two private hospitals. Up to 29% had high GDM risk factors, which fulfilled selection criteria for laboratory screening. Demographic data was complete in all women; however, incomplete documentation was observed with as much as 98% of basic data. High levels of physical activity were found in the population, and health lectures proved effective in food choices. The workforce need for diabetes care seems underestimated, but this may be better understood with reactivation of PHC services. The observations highlight behavioural change wheel issues on GDM and PHC services that need concerted focus. Two proposals are to advance the use of a ‘risk assessment and screening sheet’ for GDM screening and enlightenment of stakeholders on the central hub role of PHC in diabetes management.

Keywords: Behavioural change wheel, Community health, Diabetes education, Knowledge vs practice gap, Lifestyle, Patient follow-up, Screening services, Telehealth

Core Tip: There is a gap between knowledge and practice among stakeholders in diabetes management. Behavioural change wheel issues on gestational diabetes mellitus (GDM) and primary health care (PHC) services need concerted focus. The necessity for GDM selective screening is recognized. ‘Risk assessment and screening sheet’ needs to be employed in clinical practice. Stakeholders including individuals living with diabetes, community leadership, policy makers and health care provision staff need enlightenment to deliberately use PHC centres for diabetes management. PHC centres have a central-hub role in community health. Medical records need to include patients’ phone numbers to maximize potential for follow-up and telehealth.