A qualitative evaluation of clinicians’ experiences in diagnosis and management of women with gestational diabetes mellitus (GDM) in Pune, India

Abstract

The prevalence of gestational diabetes mellitus (GDM) continues to rise in India, and globally. However, uncertainty remains regarding its diagnosis and optimal management. We explored how clinicians in India navigate GDM-related care to identify where additional guidelines or training could buttress delivery of evidence-based care. Using purposive sampling, we conducted individual qualitative interviews with clinicians working in both public and private healthcare facilities in Pune, India. Eligible participants were 18 years or older, held an allopathic medical degree, had provided maternal care for over one year, and were involved in direct patient care. Interviews were carried out in Marathi by a trained researcher, audio-recorded, transcribed, translated into English, and analyzed thematically. Twenty clinician interviews were completed, and four key themes emerged: (1) There was disagreement over whether to use the non-fasting oral glucose challenge test or fasting oral glucose tolerance test to screen for GDM; (2) Many obstetricians viewed GDM treatment as beyond the scope of their responsibilities, preferring to refer patients to internal medicine or endocrinology specialists; (3) Institutional infrastructure such as laboratory equipment, specialists, or technicians, determined approaches to GDM screening, diagnosis, and treatment; and (4) Postpartum diabetes screening for women with GDM was uncommon due to limited tracking mechanisms and insufficient staffing. This study illuminates important inconsistencies in how GDM is diagnosed and managed in an urban area in India. Obstetricians may benefit from standardized clinical guidelines on screening, management, and postpartum follow-up could mitigate the growing burden of GDM and postpartum diabetes in India. NCT06209411, 2024-01-05.