9.3. Diabetes Mellitus

Updated 2 October 2025

Title: Standard Operating Procedure for Surveillance of Diabetes Mellitus

Effective Date: [Date]

Version: 1.0

Prepared by: [Name/Department]

Approved by: [Name/Department]

Status	Definition
A	Tested / reflects current policy and updates
B	Possible gaps / may not reflect latest policies and updates / users need to apply due diligence
C	Outline / being updated / users should cross reference other materials (job aids, training resources)
D	Draft / consider as being under development
E	Work in progress / template created

1. Introduction

This SOP outlines the procedures for the surveillance of Diabetes Mellitus (DM) in Grenada. It is intended for use by healthcare practitioners, including doctors, nurses, and allied health professionals.

2. Objectives

To provide a process of surveillance for Diabetes Mellitus

3. Scope

This SOP applies to all healthcare facilities and practitioners involved in the surveillance of Diabetes Mellitus in Grenada.

4. Definitions

See Annex 3 for definitions

5. Surveillance Procedures

5.1 Step 1: Detection – Healthcare Providers / Laboratory Personnel

Clinically evaluate and identify Diabetes Mellitus risk:

Take a detailed patient history, including name, date of birth, family history of DM, lifestyle factors, and previous medical conditions.
Perform a physical examination focusing on signs of insulin resistance, such as acanthosis nigricans and central obesity (waist to hip ratio using a non-retractable measuring tape can be used).
Assess for symptoms of hyperglycaemia, including polyuria, polydipsia, and unexplained weight loss.
Evaluate for complications of DM, such as peripheral neuropathy and retinopathy.

Diagnostic Testing

To confirm, take samples as required and send to laboratory (one of the following tests will be done, determined by the physician)

Fasting Plasma Glucose (FPG):

Measure blood glucose levels after an overnight fast (at least 8 hours).
Diagnose DM if FPG is ≥126 mg/dL (7.0 mmol/L) on two separate occasions.

Oral Glucose Tolerance Test (OGTT):

Administer a 75-gram glucose load after an overnight fast.
Diagnose DM if 2-hour plasma glucose is ≥200 mg/dL (11.1 mmol/L).

HbA1c:

Measure glycated hemoglobin to assess long-term glycemic control.
Diagnose DM if HbA1c is ≥6.5% (48 mmol/mol).

Random Plasma Glucose:

Diagnose DM if random plasma glucose is ≥200 mg/dL (11.1 mmol/L) in the presence of classic hyperglycemia symptoms.

NOTE:

Those who are diagnosed as diabetic should know their status
Those who know their status should be treated
Those treated should not have complications according to national standards.

5.2 Step 2: Reporting

Collate information on the daily reporting form, to be tallied in the weekly reporting form. Daily reporting form information includes:

Name of patient
Date of birth
Address
Name of medical institution
Diagnosis (Type 1, Type 2, Gestational Diabetes)
Medical History
Family History
Medication Prescribed
Risk factors (weight, height (BMI), level of physical activity, waist and hip circumference, alcohol consumption.

Weekly reporting form information includes:

Incidence
Prevalence
Risk factors – including - cholesterol, kidney test,
Send weekly reporting form to Epidemiology Unit

5.3. Step 3: Data Management

Data should be cleaned and analysed
Preparation of a report should be done on the evolution of the epidemiological situation of the disease
Dissemination of a weekly/monthly situation report

6. Confidentiality and Ethical Considerations

Maintain patient confidentiality and privacy at all times.
Ensure informed consent is obtained before conducting tests or treatments.
Provide non-judgmental and supportive care to all patients.
Address ethical dilemmas and ensure patient autonomy and rights are respected.

7. References

World Health Organization (WHO) Guidelines
American Diabetes Association (ADA) Guidelines
International Diabetes Federation (IDF) Guidelines
Ministry of Health, Grenada - Local Health Policies and Regulations