Knowledge attitude and practices about management of vitamin D deficiency among doctors in Pakistan

Background: Hypovitaminosis D is a common health issue in Pakistan because of its high prevalence. The awareness and practices of doctors treating vitamin D deficiency needs to be highlighted, as it will help in managing this public issue

Objectives: To assess knowledge, attitude and practices for diagnosing and treating hypovitaminosis D among practicing doctors in Pakistan

Subjects and Methods: Clinicians from different cities of the Pakistan were participated for a cross-sectional descriptive questionnaire based study about their approach in treating vitamin D deficiency. Results were analyzed using SPSS version 20. Descriptive statistics were calculated

Results: One hundred eighty eight [188] practicing doctors from 21 different cities of Pakistan participated in the study. Majority [85.6%, n=161] prescribed vitamin D levels in patients of hypovitaminosis D. It is empirically treated by 101 [53.7%]. Most clinicians [84%, n=158] prescribe Cholecalciferol, 19 [10.1%] Alfacalcidol and 11 [5.9%] prescribe Calcitriol as a vitamin D supplement, while 155 [82.4%] prescribe a maintenance dose. The prescription form preferred by doctors is tablets by 49 [26.1%], capsule by 29 [15.4%], oral injections by 68 [36.2%] and intra-muscular by 42 [22.3%]. As a follow up tool, 84 [42.6%] clinicians order serum 25 [OH] D and serum calcium levels, 102 [54.3%] assess patients by improvement in clinical symptoms and 3 [1.9%] use both strategies for assessment. Nutritional advice was also given by most doctors

Conclusion: There is no uniform approach for diagnosing and treating hypovitaminosis D among practicing doctors in Pakistan. A great variability and gap is seen in prescription options, dosing frequency and duration. This highlights the importance of need for a national guideline regarding prophylaxis, diagnosis and treatment of vitamin D deficiency

Lack of uniformity in screening, diagnosis and management of gestational diabetes mellitus among health practitioners across major cities of Pakistan

Objective: To determine knowledge, attitude and practice [KAP] regarding management of Gestational Diabetes Mellitus [GDM] among Health Care Providers in major cities of Pakistan

Methods: A knowledge, attitude and practice [KAP] questionnaire based study was conducted in major cities in Pakistan from health care providers in public and private hospitals and clinics. Questionnaires were provided to the health care providers regarding screening, diagnosis and management of patients with GDM. Data analysis was done using IBM SPSS 20

Results: A total of 210 doctors took part in the study. 55[26%] reported using fasting blood glucose as screening test for GDM whereas 129[61.4%] respondents used Oral Glucose Tolerance based WHO criteria for diagnosing GDM. Thirty six [17%] and 98[46.7%] doctors referred their patients to Gynecologists. For treating GDM, 64[30.5%] doctors prescribed insulin [NPH/Regular, 70/30 Mix]. 112[53.5] doctors used combination of capillary glucose by glucometer and plasma blood glucose tests for monitoring of glycemic control of patients with GDM

Conclusion: There is lack of agreed screening tests and criteria for diagnosis and management of GDM patients. Doctors need to be educated to follow evidence based diagnostic and management guidelines so that GDM patients can be effectively managed. Recently released South Asian Federation Societies and Pakistan Endocrine Society guidelines could be much needed consensus guidelines for doctors to apply in their daily practice to improve GDM diagnosis and treatment