Introduction
Gestational Diabetes, with approximately 200,000 cases per year in the United States, is a prevalent disease that demands immediate medical attention, particularly in severe cases, as it can pose significant risks to one’s health and sometimes even be life-threatening. The condition may persist for several months or years, underscoring the importance of proper management and ongoing care.
What is Gestational Diabetes?
Gestational diabetes is a health condition in which a woman or birth giver[1] with no prior diabetes develops elevated blood sugar levels during pregnancy. This health condition increases the risk of pre-eclampsia, depression, and cesarean section; if it is not medically resolved, the baby born to a parent with gestational diabetes may be very large, have low sugar levels afterbirth, and develop jaundice, also known as icterus. The child may be at risk of developing type 2 diabetes and being obese later in life. Other gestational diabetes risk factors include a family history of type 2 diabetes, polycystic ovarian syndrome, being overweight, and having a previous occurrence of gestational diabetes. To be able to find out the risk of developing a gestational diabetic condition, screening is advisable between 24 to 28 weeks into gestation. This health condition can be significantly prevented by engaging in physical activity and maintaining a healthy body weight before and during pregnancy. (Johns Hopkins, 2022).
Community Health Workers (CHWs)’ Roles in Reducing Gestational Diabetes
Community health workers (CHWs) include multiple categories of mid-level healthcare workers who link healthcare facilities with communities by providing referrals, health education, and preventive health measures, as well as assisting communities, individuals, and families in gaining access to therapeutic health and social services (WHO, 2018). There is significant evidence of the potential roles of CHWs in non-communicable diseases and diabetes, specifically in Low/Middle-Income Communities (LMIC). The American Association of Diabetes Educators has embraced the role of CHWs, placing them as Level 1 diabetes educators (AADE, 2014).
The World Health Organization (WHO) has established guidelines to support CHW programs; however, specific recommendations should be adapted to suit the unique environment and cultural factors of each community. This adaptation is called trans-culturalization: adapting evidence-based recommendations to different cultures and using local experts in interactive settings (Nieto-Martinez, et al., 2016).
Here are some of the roles CHWs can play in reducing the instance and impact of gestational diabetes:
Role 1: Identify individuals at high risk of diabetes and refer them to higher-level care
Identifying pregnant individuals at risk of developing diabetes is the cornerstone for timely preventive intervention. It is important for CHWs to identify those at risk to prevent them from having a higher risk of developing type 2 diabetes later in life. CHWs can also perform screening in households or organize community-based sessions and begin referrals to specialized care for individuals at high risk while continuing to support them (Ali et al, 2012).
Role 2: Facilitate lifestyle changes and diabetes self-management
Since prevention and treatment of diabetes requires compelling behavioral changes, community health workers (CHWs) can provide educational, emotional, and screening support to assist in diabetes self-management. Diabetes prevention programs have shown the long-term effect of lifestyle interventions to decrease the risk of diabetes (Egbujie, et al, 2018). Although comprehensive studies in Low /Middle-Income communities (LMIC) are scarce, a statistical analysis of interventions in the United States shaped on diabetes prevention programs revealed their effectiveness to be similar whether provided by medical personnel or educators, which include CHWs (Babagoli, et al, 2021.) Through these programs, CHWs promote physical activity and healthy diets, healthy cooking demonstrations, awareness events, and group classes, all proven methods to reduce gestational diabetes. Thus, making these programs available to birth givers, marketing and promoting the classes, and employing more CHWs, can improve health outcomes.
Role 3: Provide support to integrative medicine alternatives
While the rates of many chronic diseases are highest in LMIC, the prevalence of individuals living with multiple chronic conditions (multimorbidity) is serious; these comorbidities can influence diabetes management (Hajat & Stein, 2018). This requires a more holistic shift from previous perspectives based primarily on biological drivers instead of social and environmental factors. Employing alternative approaches may enhance trust in and adherence to CHWs’ programs and positive attitudes toward health. This includes considering traditional and culturally-inclusive healing practices, especially for patients that may come from a country in which holistic and traditional medicine is more widely practiced. With CHWs who reflect the population that the health center serves, there will be a greater awareness and understanding of these practices, and they will be more readily able to recognize when this type of intervention might be beneficial.
Thus, the gap created by both the informal healthcare sector and integrative medicine can be filled by CHWs. CHWs can help patients in their decision-making process, acting as patient advocates even if they seek alternative care by helping them communicate with healthcare professionals and other staff to obtain referrals and financial assistance. This role could further allow CHWs to discuss the pros and cons of allopathic and traditional treatments.
[1] The term “birth giver” recognizes the fact that not all those who give birth identify as a woman or as a mother, and is inclusive of all genders and sexual identities. Here is a useful article to learn more: https://hellopostpartum.com/gender-inclusive-language-pregnancy-postpartum/
Reference
Center for Disease Control and Prevention (CDC), (2022). Gestational Diabetes and Pregnancy. https://www.cdc.gov/pregnancy/documents/Diabetes_and_Pregnancy508.pdf
Johns Hopkins Hospital, (2022). Gestational Diabetes Mellitus (GDM). https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/gestational-diabetes
World Health Organization (WHO), (2018). WHO guidelines on health policy and system support to optimize community health worker programs. Geneva: World Health Organization.
American Association of Diabetes Educators (AADE), (2014). Practice levels for diabetes educators and diabetes paraprofessionals. https://www.diabeteseducator.org/docs/default-source/practice/practice-resources/praclev20168f0edb36a05f68739c53ff0000b8561d.pdf
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), (2016). Managing Diabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes
Nieto-Martinez, R., Gonzalez-Rivas, J.P., Florez, H., & Mechanick, J.I. Transcultural endocrinology: adapting type-2 diabetes guidelines on a global scale. Endocrinol Metab Clin North Am 2016; 45:967-1009.
Ali, M.K., Echouffo-Tcheugui, J., & Williamson, D.F., (2012) How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program? Health Aff (Millwood) 2012; 31:67-75
Egbujie, B.A., Delobelle, P.A, Levitt, N., Puoane, T,, Sanders, D., & van Wyk, B., (2018). Role of community health workers in type 2 diabetes mellitus self-management: a scoping review. PLoS One 2018; 13: e0198424
Knowler, W.C., Barrett-Connor, E., Fowler, S.E., Hamman, R.F., Lachin, J.M., Walker, E.A., et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393-403.
Sudhinaraset, M., Ingram, M., Lofthouse, H.K., & Montagu, D. What is the role of informal healthcare providers in developing countries? A systematic review. PLoS One 2013; 8: e54978.
Hajat, C., & Stein, E. The global burden of multiple chronic conditions: a narrative review. Prev Med Rep 2018; 12:284-93.
Babagoli, M. A., González-Rivas, J. P., Nieto-Martínez, R., Mechanick, J. I., & Sivaramakrishnan, K., (2021). Roles for community health workers in diabetes prevention and management in low- and middle-income countries. https://pubmed.ncbi.nlm.nih.gov/34730688/
Image by Natalia Lavrinenko from Pixabay
This publication is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of awards as follow: Health Outreach Partners (HOP) National Training & Technical Assistance National Cooperative Agreement totaling $847,285.00 with 0 percent financed with non-governmental sources and MHP Salud National Training & Technical Assistance Cooperative Agreement totaling $678,959.00 with 0 percent financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government. For more information, visit www.HRSA.gov