Background: In 2013, the Australasian Diabetes in Pregnancy Society (ADIPS) endorsed the recommendations of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) proposing stricter diagnostic criteria for Gestational Diabetes Mellitus (GDM). Further, optimal glycaemic thresholds for initiation of additional therapy, beyond diet and lifestyle modification, in women diagnosed to have GDM were suggested by the ADIPS based on the mean blood sugar levels for normal pregnancy.
This audit assessed the impact of the new therapeutic thresholds by determining the increase in number of patients meeting the new criteria for initiating additional therapy- predominantly insulin .
Method: We audited blood sugar transcripts maintained by the Flinders Medical Centre (FMC) Outpatient Medication Management service (OMMS) for patients diagnosed with GDM between February to September 2012, and identified the number of patients needing insulin if the new ADIPS therapeutic glycaemic thresholds were applied.
Results: During the 9 month period, 164 women with GDM were followed up by the OMMS. Using the previous therapeutic thresholds proposed by ADIPS, 100 patients (61%) met the criteria for initiatinginsulin, as compared to 123 (75%) patientswho would require insulin therapyif the new ADIPS criteria were employed. This accounts for a 14% absolute increase in number of patients requiring insulin therapy. However, 54 of the 100 patients who qualified for insulin therapy did not receive insulin therapy due to various factors, including dietary or lifestyle causes which improved with counselling.
Conclusions: The adoption of new therapeutic glycaemic targets would lead to a larger proportion of patients requiring intensive resources for counselling or initiating and managing insulin therapy. This estimate could increase further with adoption of the new diagnostic criteria and resources need to be planned to meet this need. Counselling in a targeted high risk group does yield improvements in glycaemic control.