We know that prediabetes and diabetes affect approximately six million births in India alone, of which 90 percent are due to GDM.
The year 2020 has been a remarkable year for not just doctors but all our frontline workers in the medical fraternity. Besides fighting the ongoing global pandemic, they are also overburdened with managing and handling patients with non-communicable diseases too.
A recent WHO survey of 155 countries conducted in May 2020 showed that 53 percent of the countries surveyed have partially or completely disrupted services for hypertension treatment; 49 percent for treatment for diabetes and diabetes-related complications; 42 percent for cancer treatment, and 31 percent for cardiovascular emergencies. Besides all this. the topic of mental health of everyone especially senior citizens – with the fear of contracting the virus or dying or the unknown or coping with the pandemic – is also gathering much attention.
Throughout all this, one of the significant areas which is severely overlooked and poses a threat to maternal and child health on NCD’s is gestational diabetes mellitus (GDM) or diabetes diagnosed during pregnancy. Not surprisingly, in parallel with the increase in diabetes prevalence, there seems to be an increasing prevalence of GDM which is affecting approximately five million women each year. Just like other types of diabetes, it causes high blood sugar that can affect the health of both pregnant women and unborn child.
It is important to understand that management of diabetes and its complications imposes a huge economic burden on the society; hence effective strategies are urgently needed to control this epidemic too. The prevalence of GDM has been reported to range from 3.8 percent in Kashmir to 6.2 percent in Mysore, 9.5 percent in Western India and 17.9 percent in Tamil Nadu. In more recent studies, using different criteria, prevalence rates as high as 35 percent from Punjab and 41 percent from Lucknow have been reported.
I am surprised to note that our very own unpublished data suggests that 30 percent of expecting mothers attended by our consultants have Gestational Diabetes and also we are looking at the possibility of identifying any biomarkers to diagnose them earlier. The geographical differences in prevalence have been attributed to differences in age and/or socioeconomic status of pregnant women in these regions. It is estimated that about 4 million women are affected by GDM in India, at any given time point.
Impact of gestational diabetes mellitus
GDM not only influences immediate maternal health (preeclampsia, stillbirths, macrosomia, and need for cesarean section) and neonatal outcomes (hypoglycemia, respiratory distress, increased risk of congenital heart disease) but also increases the risk of future Type 2 diabetes in mother as well as the baby. Existing literature indicates that prediabetes and diabetes affect approximately six million births in India alone, of which 90 percent are due to GDM. Children born in GDM pregnancies face an increased risk for obesity and type 2 diabetes. The cornerstone for the management of GDM is glycemic control and quality nutritional intake. GDM management is complex in India, and existing challenges are multifactorial.
Nurses as Educators
We need to understand that the diagnosis of GDM may affect women’s mental wellbeing, functioning and quality of life, with potentially negative effects on treatment adherence. Identifying and addressing the psychological and emotional needs of women with GDM could have benefits for sustainable long-term behavioural change following the affected pregnancy. Nurses are educators as they are greatly involved in educating patients to manage their disease. Existing literature has shown positive outcomes through “education” on expecting mother’s condition when nurses are involved and diabetes education helps in improving glycemic controls. They are the teachers, and they describe to the patients about their situation, informing them about the disease, possible complications, and test results. We need our nurse educators to be skilled in this teaching-learning process where they listen to the demands and needs of their patients and have a good background and understanding of diabetes, including complications and problems. Better education of the diabetic patient does provide improvement in patient self-care through a better understanding of his illness.
We need to empower our nurses
As we strive towards the global shortage of nurses, there is a need for immediate action including increasing nurse recruitment through traditional university routes and expanding new roles and apprenticeship routes. Each approach requires clinical workplaces to increase their teaching capacity while supporting the existing workforce to provide first-class care. NCDs have higher morbidity and mortality especially with the cost of the drugs. Nurses are advanced caregivers and motivators they play a crucial role in advising the patients about many non-pharmacological modalities which help them to reduce the medications — dietary advice, lifestyle changes etc. Nurses have a crucial role in educating expectant mothers and nursing mothers on this.
Non- communicable diseases (NCDs) are the leading cause of death globally, killing more people each year than all other causes combined but these diseases are largely preventable. These diseases can be effectively treated and controlled. We can turn the tide. But we have a long way to go.
The author is a Neonatologist and is the Founder-Chairman at Cloudnine Group of Hospitals