Diabetes in pregnancy – notes from the diabetes midwives
Diagnosis of GDM
The Maternity Diabetes Specialist Nurse Service performs a modified Oral Glucose Tolerance Test (OGTT) to diagnose gestational diabetes mellitus (GDM), using a 75g load of glucose (440 mls Lucozade). The diagnostic threshold has now changed according to recent NICE guidance. GDM should be diagnosed if the blood glucose is 7.8mmol/l or more at two hours after the 75g glucose load. (The threshold used to be 7.0mmol/l)
Preparation of women with diabetes for pregnancy
The RBFT participates in the National Pregnancy in Diabetes Audit, which looks at the outcomes for pregnancies affected by Type 1 and Type 2 diabetes. The aim is to see if women were well prepared before embarking on their pregnancy. This is the first year that we could compare local with national data. Comparison of RBFT data vs national data from NPID audit 2015:
The clear message here is that women are not prepared for pregnancy as too few have an acceptable HbA1c and too few women with Type 2 are taking folic acid in preparation. What we are good at is early referral to the diabetes midwives, so well done to primary care for that.
Referral of patients to the diabetes maternity service
Please refer patients straight away to this service, as soon as you know they are pregnant. Simply call 0118 3227245 and leave a message with patient details, including their phone number. One of the midwives will call the patient back ASAP and arrange to see them.
Pilot programme for remission of Type 2 diabetes at RBFT
In 2016 the RBFT recruited a small number of patients to a pilot programme aimed at bringing about remission of Type 2 diabetes by using a liquid very low calorie diet (VLCD) of 800kcal/day initially. Early results are impressive. They are now recruiting another cohort. Do you know any patients who might like to do this? Eligibility criteria as follows:
Type 2 diabetes for <5 years
Not using injectable therapy (insulin/GLP-1)
Not with an eating disorder or major psychiatric illness
Really impressive results are coming out. The Quality Premium in diabetes for North and West Reading, South Reading and Newbury and District Clinical Commissioning Groups was to reduce the proportion of patients with HbA1c>75 by 2% from baseline. Results in Q3 (so still three months to go) show the following reductions:
North and West Reading CCG - 2.1%
South Reading CCG - 2.0%
Newbury and District CCG - 1.3% and
Wokingham CCG - 2.6%
Clearly Wokingham CCG should have done this Quality Premium!
You can find detailed information down to practice level on the website here.