My Experience in Lima, Perú: Diagnosing and Managing Gestational Diabetes

Dates of Travel: October 21, 2021 - November 3, 2021
Location: Lima, Perú (Hospital Nacional Docente Madre Niño San Bartolomé)
Mentors: Dr. Julio Leey (University of Florida, USA) and Dr. Edwin Acho (Lima, Perú)

The Lewis E Braverman Endocrine Fellow in Training Educational Grant allowed me to have the unique experience to travel to Lima, Peru for a clinical rotation. The clinical experience was focused on the diagnosis and management of pre- and gestational diabetes in low-income settings. I also saw other endocrinopathies such as: PCOS, thyroiditis, obesity, thyroid nodules, prolactinemia and others during pregnancy. The rotation took placed at the Hospital Nacional Docente Madre Niño San Bartolomé, a tertiary hospital that specializes in maternal health with approximately 200 beds and 6,000 newborn deliveries annually. I joined Dr. Edwin Acho (local endocrinologist) in the inpatient and outpatient Endocrinology service for two weeks.

The main challenge with managing pregnancy related diabetes was the monitoring of specific strict pregnancy glycemic targets due to the inability of patients to afford glucose strips and a glucometer. We would rely on both serum fasting glucose levels and 1-hour post prandial levels collected in the laboratory two days prior to their appointments. Patients were followed weekly and if severe hyperglycemia was detected, they would be hospitalized for management. I was able to help some patients by bringing samples of continuous glucose monitoring that were placed during clinic visits and data was used to adjust therapy. Most patients were able to achieve glycemic targets with personalized dietary plan and close follow-up with a certified nutritionist. Nutritional plans were created based on FIGO recommendations but would take into consideration the Peruvian cuisine and patient preferences.

After clinic and inpatient rounds, Dr. Acho would provide pathophysiology, diagnosis, and treatment reviews with emphasis on gestational diabetes and pregnancy-related endocrinopathies. This was a good opportunity to discuss management differences between the United States and Peru.

This was a beautiful learning experience where I learned about the challenges of a Latino population in diagnosing and managing diabetes in pregnancy when resources are limited. I not only learned from the different patient population I was exposed to, but from the local endocrinologist, medicine residents, and staff. Moreover, I was also able to teach the residents about the CGM technology that is not well accessible in Lima, Peru. As a young trainee in Endocrinology, this humbling experience not only made me a better clinician but also appreciative of the work we do. I would encourage other fellows to apply to this grant to truly enhance their training experience in an area of their preference while also enjoying visiting a different country and being welcomed by the warmth of an amazing culture.

The Dr. Lewis E Braverman Endocrine Fellow in Training Educational Grant is a one-of-a-kind grant program offered to fellows in the United States to take part in unique clinical experiences worldwide. 2022 Application Opens June 30, 2022

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María Del Mar Morales Hernández, MD