Adaptation of the IDF WINGS programme for Hyperglycaemia in Pregnancy in
Guyana, South America.
Abstract
Objective: Introduced of a protocol for the outpatient management of
hyperglycaemia in pregnancy (HIP) in Guyana based on the IDF WINGS
programme Design: Quality improvement programme and education
intervention Setting: The national referral hospital in Georgetown
(GPHC) and two associated community health centres (HC). Population:
Pregnant women of <37weeks gestational age. Methods: An
inter-professional team of clinical leaders introduced universal
screening for gestational diabetes (GDM)using a 75gm OGTT and simplified
outpatient management of HIP with self-monitoring of blood glucose, diet
followed by metformin then insulin. Main Outcome Measures: Numbers of
women screened, diagnosed and treated for HIP. Results: Between November
2016 and 1st July 2019, 2226 pregnant women were screened, 461 25.9%)
were abnormal at GPHC and 12 (2.6%) at the HC. Forty-four% were
treated with medical nutritional therapy alone, 43% required metformin
and 13% received insulin. Caesarian section rates were high (46%) and
attendance for postpartum OGTT poor (15%). Conclusions: The high rate
of positive tests at GPHC is consistent with the system of transferring
high risk patients to GPHC. Before supporting a nationwide universal
screening programme, further investigation is required, eg screening for
GDM at regional hospitals and HC outside the immediate GPHC catchment.
Our results suggest universal screening may not be the only choice for
the populations of low-and-middle income countries. Funding: World
Diabetes Foundation (WDF) and the Banting and Best Diabetes Centre
(BBDC) of the University of Toronto. Keywords: Hyperglycaemia in
pregnancy, diabetes, oral glucose tolerance test.