Management of gestational diabetes by physicians in Turkey.
OBJECTIVE
We sought to investigate the practice patterns of clinicians (family physicians, internists and obstetricians) in Turkey in screening for gestational diabetes mellitus (GDM), management and monitoring of hyperglycaemia in pregnant women with GDM, and assessment of glucose tolerance in the postpartum state.


METHODS
Between January and December 2007, current practices of Turkish physicians (n=434) were assessed by a questionnaire which was concerned with physician demographics and clinical practice including screening and diagnostic methods for GDM, management of GDM during pregnancy and postpartum assessment of glucose tolerance. The questionnaire was developed in respect to the recommendation of the Fifth International Workshop-Conference on GDM and the standards of the American Diabetes Association (ADA).


RESULTS
Although most of the physicians stated that they performed screening for GDM and postpartum screening for glucose intolerance in women with GDM, their screening practices vary. The proportion of women who were provided with a nutrition counselling by a registered dietician and a patient education by a trained nurse was low, especially in women treated by the family physicians. Home glucose monitoring was widely used in the management of GDM, however, postprandial glucose assays were used occasionally. Regular and NPH insulin preparations were the most preferred drugs to treat GDM. Internists were more likely to use insulin analogues. On the other hand, a significant number of physicians stated that they used oral antidiabetics (OADs). A considerable number of family physicians used OADs which have not been proved to be safe in pregnancy.


CONCLUSIONS
Our results suggest that there is considerable variation in the clinical practice patterns of physicians. An education program to enhance the clinical aptitude of physicians, particularly family physicians, in the medical management of GDM should be designed throughout the country.
Akinci
Baris
B
Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University Medical School, Inciralti, Izmir 35340, Turkey. baris.akinci@deu.edu.tr
Tosun
Pinar
P
Bekci
Emine
E
Yener
Serkan
S
Demir
Tevfik
T
Yesil
Sena
S
D000328:Adult; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D002983:Clinical Competence / Q000706:statistics & numerical data; D003376:Counseling / Q000706:statistics & numerical data; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000188:drug therapy*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D005951:Glucose Tolerance Test / Q000706:statistics & numerical data; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D015596:Nutrition Assessment; D009774:Obstetrics / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D011181:Postnatal Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey
D007004:Hypoglycemic Agents