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.