Farhanah Ahmad Shuhaimi - Current Dietetic practices in the management of GDM a suvey of Malaysian dietitians

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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Health & Medicine

Farhanah Ahmad Shuhaimi - Current Dietetic practices in the management of GDM a suvey of Malaysian dietitians