Gestational diabetes mellitus prevalence in Maela refugee camp on the Thai–Myanmar Border: a clinical report

Abstract

Background: Individuals in conflict-affected areas rarely get appropriate care for chronic or non-infectious diseases. The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide, and new evidence shows conclusively that the negative effects of hyperglycemia occur even at mild glucose elevations and that these negative effects can be attenuated by treatment. Scientific literature on gestational diabetes in refugee camp settings is critically limited. .0] when the cut-off determined by the HAPO trial was applied. Applying the older WHO criteria yielded a prevalence of 6.6% (95% CI 3.3Á9.8). Age, parity, and BMI emerged as characteristics that may be significantly associated with GDM in this population. Other risk factors that are commonly used in screening guidelines were not applicable in this diabetes-naïve population. Discussion: The prevalence of GDM is lower in this population compared with other populations, but still complicates 10% of pregnancies. New evidence regarding gestational diabetes raises new dilemmas for healthcare providers in resource-poor settings. Efforts to identify and treat patients at risk for adverse outcomes need to be balanced with awareness of the risks and burdens associated with over diagnosis and unnecessary interventions. Screening approaches based on risk factors or using higher cut-off values may help minimize this burden and identify those most likely to benefit from intervention.

Impact of adopting the 2013 World Health Organization criteria for diagnosis of gestational diabetes in a multi-ethnic Asian cohort: a prospective study

“…However, reported changes in GDM rates have varied across studies of Asian populations. The 2013 WHO criteria diagnosed more GDM cases in the studies by Pan et al [21] from China (7.7% vs. 6.8%, n  = 17,808) and Gilder et al [24] from Thailand (10.1% vs. 6.6%, n  = 228), a similar proportion of GDM cases in the study by Sagili et al [25] from India (12.6% vs. 12.4%, n  = 1231), and fewer GDM cases in studies by Tran et al [26] from Vietnam (20.4% vs. 24.3%, n  = 2772) and Yew et al [20] from Singapore (21.1% vs. 28.8%, n  = 855). These disparities and data from our study and others’ [27] support the notion of variation in glycaemic responses to a glucose load in pregnancy among different Asian ethnicities.…”

The burden of diabetes and use of diabetes care in humanitarian crises in low-income and middle-income countries

“…25 The only study conducted in South-East Asia reported the prevalence of GDM in a refugee camp at the Thai-Myanmar border, screening pregnant women with a 75mg oral glucose tolerance test (OGTT). 35 Although the sample size was small and the number of all pregnant patients in the catchment area was not recorded, the estimated prevalence rate was 10.1% using HAPO trial cutoff values. 58 In Africa, the only identified study was a retrospective study evaluating mortality patterns based on chart review at a hospital in Liberia.…”

“…All studies were published between 1992 and 2018, with thirty-three published since 2011. Thirty-eight studies reported on populations affected by armed conflict, [17][18][19][20][21][22][23][24][25][27][28][29][30][31][32][33]35,36,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] two reported on populations affected by natural disasters, 34,37 and one on all crisis types. 26 Thirty-four studies were conducted in the protracted crisis phase (crisis duration greater than six months), [17][18][19][20][21][22][23][24][25]…”

“…26 Thirty-four studies were conducted in the protracted crisis phase (crisis duration greater than six months), [17][18][19][20][21][22][23][24][25][27][28][29][30][31][32][33]35,[39][40][41][42][43][44][45][46][47][48]50,[52][53][54][55][56][57] three in the emergency response phase (immediate aftermath of the event up to six months), 36,49,51 two in the early recovery phase (more stable period of rebuilding up to two years following the crisis), 34,38 and two reported on multiple crises phases. 26,37 Twenty-five studies addressed refugee populations, [17][18][19][20][21]25,26,…”

“…Three studies focused exclusively on T1D, 27,49,51 eight categorized patients into T1D and/or T2D, 24,32,33,40,41,47,52,53 and two reported on women with GDM. 21,35 Atypical forms of diabetes were not addressed. Only eighteen studies 17,18,[20][21][22][23]25,[28][29][30][31]33,45,46,50,52,55,56 assessed the burden of diabetes at the population level using probabilistic sampling (rather than health-facility level using nonprobabilistic sampling) and the majority of these relied on self-report rather than medical diagnosis.…”