Self-Monitoring of Blood Glucose for Gestational Diabetes Mellitus: A Nationwide Survey of Perspectives and Clinical Practices among Clinicians in India

Abstract

Self-monitoring of blood glucose (SMBG) is an essential part of gestational diabetes mellitus (GDM)
management. However, there is still a lack of adherence to SMBG in India, and it is unclear how actual clinician practices affect
its uptake. This study evaluated the knowledge, attitudes, and practices of gynecologists and endocrinologists/diabetologists
in India towards SMBG. Methods: A cross-sectional, digital knowledge, attitude, and practice (KAP) survey was conducted
from May to July 2025 among 588 clinicians (311 endocrinologists/diabetologists and 277 gynecologists). Two validated,
structured questionnaires captured awareness of guideline recommendations, attitudes toward SMBG, perceived patient
barriers, and routine clinical practices. Responses were summarized using descriptive statistics. Results: A strong adherence
to national guidelines was shown by both gynecologists and endocrinologists/diabetologists. Gynecologists identified patient
noncompliance and lack of motivation, psychological resistance, and discomfort from repeated finger pricks as major obstacles,
while endocrinologists emphasized on cost associated with glucose monitoring devices and strips, lack of acceptance, and
limited knowledge on SMBG techniques. SMBG was widely recommended for insulin-treated GDM, but attitudes toward its
role in lifestyle-controlled GDM varied. Although postpartum follow-up and referral patterns remained uneven, the majority
of clinicians concurred that SMBG supports timely therapy decisions. Conclusion: Initiating SMBG at the level of gynecologists
itself promotes earlier glycemic stabilization, which is essential for improving perinatal outcomes and reducing the burden of
future diabetes and metabolic complications.