Aim: One aim of the Guyana Diabetes Care Project was to introduce a protocol for the outpatient management of diabetes in pregnancy in Guyana.
Methods This was the outcome of collaboration between: The Banting and Best Diabetes Centre (BBDC) of the University of Toronto, the Ministry of Public Health (MOPH) of Guyana, and WONDOOR Global Health Program of the University Hospitals, Cleveland, Ohio. We developed an inter-professional team of clinical leaders and introduced a recognized method of universal screening for GDM at the national referral hospital in Georgetown (GPHC). A simplified outpatient management of hyperglycaemia in pregnancy was also pioneered using medical nutrition therapy followed by metformin then insulin monitored by self-monitoring of blood glucose with a 10point weekly profile, rather than automatic admission to hospital for monitoring and insulin treatment. Following the introduction of the programme at GPHC, it was introduced at 2 associated community health centres (HC).
Between October 2016 and the end of April 2018, 2156 pregnant women were referred to GPHC. Twelve women were referred with Type 2 diabetes found before 24 weeks gestation. One thousand one hundred and sixty (54%) pregnant women between 24-37 weeks gestation were screened, 955 at GPHC and 205 at the HC. 294 women (25%) had positive 75gm OGT tests, 285 (30%) at GPHC and 9 (4%) at the HC.
The high rate of positive tests at GPHC suggests that this is a high-risk population. The low rate at associated health care centres is consistent with the current system of transferring high risk patients to GPHC. Before supporting a nationwide universal screening programme in preference to a high-risk screening programme, staff feel that further work is required, for example a pilot programme of screening for GDM at regional hospitals & health centres outside the immediate Georgetown hospital catchment area. Our results suggest universal screening may not be the only choice for low and middle income populations.