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Diabetes Special Report
The Dhaka Declaration—
Bringing Gestational Diabetes Mellitus (GDM) to Center Stage
Faruque Pathan, 1 Sarita Bajaj, 2 Dina Shrestha, 3 Syed Abbas Raza, 3 Noel Somasundaram, 3
Tofail Ahmed, 4 Rakesh Sahay, 5 and Sanjay Kalra 3
1. President, South Asian Federation of Endocrine Societies; 2. Founder President, South Asian Federation of Endocrine Societies;
3. Vice Presidents, South Asian Federation of Endocrine Societies; 4. Founder Secretary, South Asian Federation of Endocrine Societies;
5. Secretary, South Asian Federation of Endocrine Societies
Abstract This special report covers The Dhaka Declaration, an initiative of the five-nation South Asian Federation of Endocrine Societies (SAFES). Involving
Bangladesh, India, Nepal, Pakistan, and Sri Lanka, this endocrine association aims to bring gestational diabetes mellitus (GDM) to the center
stage of clinical medicine as well as public health. The Dhaka Declaration provides guidance for advocacy, research, and guideline formation in
the field of GDM. Through these activities, SAFES hopes to bring about universal screening, uniformity in diagnosis, optimal management, and
regular follow-up of GDM.
Keywords Advocacy, diabetes, GDM pre- and postnatal management, guideline formation for GDM, pregnancy, research, screening
Disclosure: Faruque Pathan, Sarita Bajaj, Dina Shrestha, Syed Abbas Raza, Noel Somasundaram, Tofail Ahmed, Rakesh Sahay, and Sanjay Kalra have no conflicts of interest to
disclose. No funding was received for the publication of this article.
Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and
reproduction provided the original author(s) and source are given appropriate credit.
Received: October 14, 2015 Published Online: October 25, 2015 Citation: US Endocrinology, 2015;11(2):81–2
Correspondence: Sanjay Kalra, MD, DM, Department of Endocrinology, Bharti Hospital, Karnal, India. E: firstname.lastname@example.org
South Asia—Diabetes Capital
South Asia is known as the Diabetes Capital of the World, and justifiably
so. Home to three of the world’s largest populations of people living with
diabetes (India, Bangladesh, and Pakistan), it also includes nations with
an equally high prevalence of diabetes (Bhutan, Maldives, Nepal, and
Sri Lanka). With diabetes having entrenched itself in the South Asian
populace, it is now considered an endemic, rather than an epidemic. 1
Gestational Diabetes Mellitus
Epidemics of disease usually require interventions that are designed to
show rapid control that may be short term. Endemics, on the other hand,
need long-term measures that help contain the illness and lead to long-
lasting benefit as well.
It is in this context that the five-nation South Asian Federation of Endocrine
Societies (SAFES) released The Dhaka Declaration in April 2015. Led by
Professor Hajera Mahtab of Bangladesh, experts from Sri Lanka, Pakistan,
Nepal, India, and Bangladesh identified gestational diabetes mellitus
(GDM) as a focus area for the coming 2 years. 2
The Dhaka Declaration—From Thoughts to Words
GDM was chosen because of its public health importance, 3 the opportunity
it provides for interspecialty and interprofessional collaboration, and the
Tou ch MEd ica l MEdia
availability of evidence-backed nonpharmacologic and pharmacologic
interventions that can favorably impact health-related outcomes. 4 Most
importantly, GDM was identified to have a transgenerational influence on
health, affecting not only the woman with GDM, during and after pregnancy,
but also the offspring, in utero, in infancy, and later in adult life as well.
The Dhaka Declaration lists various aims and describes the activities to
be conducted across all South Asian countries. In the declaration, SAFES
resolves to facilitate universal screening, uniformity in diagnosis, and
optimal management and follow-up of GDM, including appropriate usage of
insulin. It also proposes indicators or markers to assess progress in this field.
From Words to Action
Six months after the Dhaka Declaration was released, SAFES met again
to plan a course of action. At a meeting held on October 1, 2015, in
Colombo, Sri Lanka, 30 participants shared a situational analysis of GDM
in their home countries and prepared a research map to help identify
missing gaps in knowledge related to GDM. The South Asian girl child
was at the center stage. Focused group discussions on preconception
management, screening, and antenatal management, as well as
postpartum follow-up, were held. Emphasis was laid on creating a
research-friendly environment and facilitating pan-South Asian research
in an inclusive manner.