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CURRENT DIETETIC PRACTICES IN THE MANAGEMENT OF
GESTATIONAL DIABETES MELLITUS: A SURVEY OF MALAYSIAN DIETITIAN
Farhanah AS, Fatin Nasirah MD and Barakatun Nisak MY
Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang,
Selangor
MDA Scientific Conference Kuala Lumpur, 23rd June 2013
INTRODUCTION • Gestational Diabetes Mellitus (GDM) has become a problem that
affects significant number of women during pregnancy
• The prevalence of GDM has increased worldwide by 50% 1
Ferrara, et al. Diabetes Care: 1625-1630 2002
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INTRODUCTION
• Women who have had history of Gestational Diabetes Mellitus have a 35% to 60% chance of developing diabetes1
-Their offspring are at risk of glucose intolerance, T2DM and obesity2
• Medical Nutrition Therapy (MNT) is one of the crucial strategies in the management of GDM
1.National Diabetes Fact Sheet, 2011
2. American Diabetes Association. Diabetes Care 26(1): S103-S105 2003
MDA Scientific Conference Kuala Lumpur,
23rd June 2013 3
INTRODUCTION
• Role of dietitian in the management of Gestational Diabetes Mellitus (GDM) is highly recognized
• However, agreed approaches to dietetic practice in Malaysia for the management of GDM are scarce
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OBJECTIVES
1. To examine current dietetic practice in the management of GDM
2. To compare nutrient recommendations provided by dietitians with several established international guidelines
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METHODOLOGY
STUDY DESIGN Cross-sectional mail survey
SAMPLE All dietitians working at government sector who provide MNT to women with GDM
TOOL : QUESTIONNAIRES 33-item questionnaire -demographics characteristics
-provision of dietetic services
-nutrition recommendation
-intervention
-post-natal care
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RESULTS
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RESULTS:
• RESPOND RATE:
• 68% (148 questionnaires posted, 101 returned)
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RESULTS: DEMOGRAPHIC CHARACTERISTIC OF DIETITIANS
PERCENTAGE (%)
GENDER Male Female
7 93
EMPLOYMENT SECTOR Public Hospital Teaching Hospital Health Clinic
84 11 5
YEARS OF DIETETIC PRACTICE 1-3 years 3-5 years 5-10 years 10 -20 years
25 22 41 12
SEEN WOMEN WITH GDM Yes No
80 20
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RESULTS: SEEING GDM CLIENT PER DAY SINCE THE LAST 3 MONTH
14
53
10 4.5
0
10
20
30
40
50
60
70
80
90
100
< 4 5 to 9 9 to 12 > 12
PER
CEN
TAG
E (%
)
NUMBER OF GDM CLIENT
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RESULTS: INITIATION OF MNT
57
30
6 5
0
10
20
30
40
50
60
70
80
90
100
< 1 week 1 - 2 week 3 - 4 week > 1 month
PER
CEN
TAG
E (%
)
INITIATION OF MNT
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RESULTS: FOLLOW UP SERVICES
53
47 YES NO
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RESULTS: FREQUENCY OF FACE-TO-FACE VISIT THROUGHOUT THE PREGNANCY
21
28
1
0
5
10
15
20
25
30
One Two - Three Four - Five
PER
CEN
T (%
)
DIETETIC CONSULT PER CLIENT
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RESULTS: MEAL PLANNING METHOD FOR GDM MOTHERS
82
62
54
43
37
11
0 20 40 60 80 100
Flexible CHO portions/ exchanges
Small meals spread out over the day
Portion control by using plate method
Fixed CHO portion/ exchanges
Healty dietary guidelines based onMalaysian food pyramid
Glycemic index
PERCENTAGE OF DIETITIAN (%)
MEA
L P
LAN
NIN
G M
ETH
OD
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RESULTS: MACRONUTRIENT RECOMMENDATION
MACRONUTRIENT %
Carbohydrate 50 - 60
Protein 15 - 20
Fat 20 – 30
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COMPARING CURRENT MACRONUTRIENT RECOMMENDATIONS WITH SEVERAL
ESTABLISHED INTERNATIONAL GUIDELINES
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CARBOHYDRATE
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• 50% - 60% MALAYSIA
• 40%-45% MEXICO1
• 40-45% CALIFORNIA2
• 35- 45% ADA3
1. Perera et al. 2009 The Diabetes Educator 35:1004-1013 2. California Division North Nutritional Services. 2007
3. American Dietetic Association 2003 Diabetes Care 26: S103-S105
PROTEIN RECOMMENDATION
MALAYSIA INDIA1 US 2 CANADA3
15%-20% 20% 20% 15%-20%
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1. Addressing Gestational Diabetes Mellitus A Reference Manual. 2011. Swami Vivekananda Youth Movement 2. Managing Gestational Diabetes. 2004. NICHD
3. SUNDEC- Diabetes Education Centre. 2009
FAT RECOMMENDATION
• 20%-30% MALAYSIA
• 40% CANADA1
• 25% INDIA2
• 28% US3
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1. SUNDEC- Diabetes Education Centre. 2009 2. Addressing Gestational Diabetes Mellitus A Reference Manual. 2011. Swami Vivekananda Youth Movement
3. Managing Gestational Diabetes. 2004. NICHD
CONCLUSION
• Consistency was seen in key component of nutrition intervention
• But the were differences in nutrient recommendation – dietary carbohydrate
• Indicates the need of having agreed approaches to dietetic practice guidelines for the management of GDM.
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RECOMMENDATION
• Develop a standardize MNT guideline for GDM in Malaysia, thus could optimize the pregnancy and obstetric outcomes from MNT
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ACKNOWLEDGMENT
• Universiti Putra Malaysia
• Melinda K. Morrison, Education and Prevention Division, Australian Diabetes Council Sydney.
• Tn Hj Ridzoni, HOD Dietetic & Food Services Department, HKL
• All the dietitians participated in this study
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THANK YOU
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