Screening and management of gestational diabetes in Mexico: results from a survey of multilocation, multi-health care institution practitioners

Abstract

Purpose: To identify the most common practices implemented for the screening and treatment of gestational diabetes mellitus (GDM) and to estimate the GDM clinician-reported proportion as a proxy of the incidence in Mexico.

Materials and methods: Three hundred fifty-seven physicians in four major cities were asked about their practices regarding GDM screening, treatment, clinical exams, and health care staff involved in case of GDM diagnosis, as well as the percentage of women with GDM they care for. Data management and statistical analyses were done with Stata 13.

Results: The overall GDM clinician-reported proportion was 23.7%. Regional differences were expected and consistent with the data on the epidemiology of the obesity in the country. The most common screening test was the oral glucose tolerance test 75 g one step (46.6% of total cases). Diet and exercise were sufficient to treat GDM in 40.6% of cases; the rest of the sample relied on some form of medication, especially oral hypoglycemic agents (63.0% of cases), insulin (22.0%), or a combination of these (13.0%). To educate women on how to measure glycemia and eventually take medications, an average of 2-3 hours were necessary. The three most common prenatal screening tests were the "no stress", the "Doppler ultrasound", and the "biophysical profile", respectively, taken at least once by 70%, 60%, and 45% of women. Among women who were prescribed insulin, only 37% managed to keep the initial prescribed dose during the whole pregnancy.

Conclusion: The survey confirmed the expected incidence and gave interesting results on the treatment of GDM. The current Mexican guidelines seem to have been partially implemented in practice, and a coherent national strategy for GDM is still missing. More studies are encouraged to investigate this topic, with the aim to better understand the importance of the monetary cost of GDM, which is currently underestimated.

Keywords: GDM incidence; pharmacological treatment; prenatal test.

Figure 1

Distribution of prescribed medications by health care institution. Abbreviations: IMSS, Instituto Mexicano del Seguro Social; ISSSTE, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado; OHA, oral hypoglycemic agents; SSA, Secretaría de Salud.

Figure 2

Distribution of prescribed medications by city. Notes: However, when comparing the OHA to the other medications, we did not find any statistically significant difference but the one between Monterrey and Mexico City (Table 4). Abbreviation: OHA, oral hypoglycemic agents.