Capacity Building of Primary Care Physicians in Gestational Diabetes by IDF Recognized (2015-16) GDM Course: Saving the Lives of Two Generations
Haresh Chandwani 1, Sandeep Bhalla1, R. Unnikrishnan2, Nikhil Tandon3,
D. Prabhakaran1, V. Mohan2           

1Public Health Foundation of India, India
2 Dr. Mohan’s Diabetes Education Academy (DMDEA), India
3 All India Institute of Medical Sciences, India

Background: It is estimated that 16.2% of live births are affected by some form of hyperglycaemia in pregnancy in 2015, of which 90% are due to GDM. Pregnancies complicated by GDM have  fourfold increased risk of perinatal mortality and has a long-term health impact, with more than 50% of women with GDM going on to develop type 2 diabetes within 5-10 years of delivery. In India an estimated 4 million women have GDM. 
Aims: The aim of this abstract is to highlight the components of a PAN India training model specifically designed to enhance the knowledge, skills, and core competencies of Primary Care Physicians (PCPs) in the management of GDM.
Methodology. There is a dearth of trained professionals in specialised area like gestational diabetes, which adds to the rising epidemic of diabetes in India and worldwide. Addressing this issue by building the capacity of primary care physicians is an important strategy towards improving GDM management. A four modular course was developed jointly by Public Health Foundation of India and DMDEA to train primary care physicians with strong course curriculum, vetted and approved by the eminent panel of national experts constituting of eminent endocrinologists and gynaecologists. 

The contact based program spread across 4 months having four modules follows standardized guidelines & protocols which is delivered through judicious mix of lectures, case studies and interactive one to one session by proficient and trained faculty. Each training centre has one Diabetologist/ Endocrinologist and one Gynaecologist/ Obstetrician. The quality of the course is evaluated and assured through random visits, key informant interviews, and electronic feedback by qualified observers. The pre- requisite qualification for course enrolment is MBBS with 3 years’ experience as a practising physician which was in lieu of the core standards set across by the program. The education material provided is resource sensitive and up-to-the-minute.  Timely assignment and assessment review is done to evaluate the participants understanding of the subject
Result: 
Certificate Course in Gestational Diabetes Mellitus (CCGDM) commenced its remarkable journey in 2012 as a 4 modular course to train primary care physicians, obstetricians and gynecologists. CCGDM has trained more than 3200 participants and covered 26 states, 3 Union Territories (UT`s), 257 districts & 437 cities in the last 4 cycles. The program was piloted by 128 trained regional faculty and monitored by 25 observers. CCGDM model has also been adopted by three state governments- Gujarat, Madhya Pradesh and Meghalaya for training of their medical officers.
Out of the trained pool of participants, 52% were post- graduates with average 11 years clinical experience & 39 % were from Government sector. The program’s robust monitoring mechanism and precise certification method ensured 90% pass percentage. Approx. 92% of trained physicians claimed that the program helped them in better diagnosis, timely referral and management of GDM patients with significant knowledge improvement.
In the year 2014, International Diabetes Federation (IDF) recognized CCGDM model and   South Asian Federation of Endocrine Societies (SAFES) accredited it and in 2015 received PHD Chamber Award and FICCI Healthcare Excellence Award for its skill development. This model was also selected for presentation at “Third National Summit on best practices and innovations in public health care systems in India”, organized by MoHFW, Government of India, in August 2016, at Tirupathi, Andhra Pradesh and was published in Good, replicable and innovative practices coffee table book 2016 by NHSRC – “Winds of Change”.
Conclusion: 
Focusing on gestational diabetes is a low-cost intervention both to improve maternal and child health as well as to prevent future diabetes. Providing screening and care to mothers at risk of gestational diabetes by training PCPs is likely to have a multi-generational impact on the beneficiaries as well as on health care systems and budgets. CCGDM is a well- defined model to build capacity among doctors in GDM Management. This progressive training model has the potential to be adopted by low income countries.

Capacity building of primary care physicians in gestational diabetes by IDF recognized (2015-16) GDM Course