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

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

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

    • 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 MDA Scientific Conference Kuala Lumpur, 23rd June 2013 2
    • 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 MDA Scientific Conference Kuala Lumpur, 23rd June 2013 4
    • 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 MDA Scientific Conference Kuala Lumpur, 23rd June 2013 5
    • 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 MDA Scientific Conference Kuala Lumpur, 23rd June 2013 6
    • RESULTS MDA Scientific Conference Kuala Lumpur, 23rd June 2013 7
    • RESULTS: • RESPOND RATE: • 68% (148 questionnaires posted, 101 returned) MDA Scientific Conference Kuala Lumpur, 23rd June 2013 8
    • 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 MDA Scientific Conference Kuala Lumpur, 23rd June 2013 9
    • 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 PERCENTAGE(%) NUMBER OF GDM CLIENT MDA Scientific Conference Kuala Lumpur, 23rd June 2013 10
    • 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 PERCENTAGE(%) INITIATION OF MNT MDA Scientific Conference Kuala Lumpur, 23rd June 2013 11
    • RESULTS: FOLLOW UP SERVICES 53 47 YES NO MDA Scientific Conference Kuala Lumpur, 23rd June 2013 12
    • 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 PERCENT(%) DIETETIC CONSULT PER CLIENT MDA Scientific Conference Kuala Lumpur, 23rd June 2013 13
    • 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 on Malaysian food pyramid Glycemic index PERCENTAGE OF DIETITIAN (%) MEALPLANNINGMETHOD MDA Scientific Conference Kuala Lumpur, 23rd June 2013 14
    • RESULTS: MACRONUTRIENT RECOMMENDATION MACRONUTRIENT % Carbohydrate 50 - 60 Protein 15 - 20 Fat 20 – 30 MDA Scientific Conference Kuala Lumpur, 23rd June 2013 15
    • COMPARING CURRENT MACRONUTRIENT RECOMMENDATIONS WITH SEVERAL ESTABLISHED INTERNATIONAL GUIDELINES MDA Scientific Conference Kuala Lumpur, 23rd June 2013 16
    • CARBOHYDRATE MDA Scientific Conference Kuala Lumpur, 23rd June 2013 17 • 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% MDA Scientific Conference Kuala Lumpur, 23rd June 2013 18 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 MDA Scientific Conference Kuala Lumpur, 23rd June 2013 19 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. MDA Scientific Conference Kuala Lumpur, 23rd June 2013 20
    • RECOMMENDATION • Develop a standardize MNT guideline for GDM in Malaysia, thus could optimize the pregnancy and obstetric outcomes from MNT MDA Scientific Conference Kuala Lumpur, 23rd June 2013 21
    • 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 MDA Scientific Conference Kuala Lumpur, 23rd June 2013 22
    • THANK YOU MDA Scientific Conference Kuala Lumpur, 23rd June 2013 23