Gestational Diabetes Mellitus
(GDM) is usually managed by secondary care in our
CCG area & we in primary care support them with providing medications,
arranging investigations & immediate help as needed.
On enquiring, I
realised that there is no written protocol for the shared care between primary
& secondary care for managing GDM. This led me to consider an audit to check
if we as a practice were providing adequate care & follow up for these
patients, especially in the post-partum period (when secondary care usually
discharges them to our care), as recommended by the NICE guidelines.
I was conscious of the fact
that women with GDM are at increased risk of developing diabetes post- partum,
which if undiagnosed could increase risks of complications to the patient’s
health in future (including future pregnancies). This would lead to increase stress
on the already over-stretched NHS, along with the negative impact it may have
on the patient’s quality of life.
NICE guidelines recommend the
following for post-partum care1:
Offer lifestyle advice including weight
control, diet and exercise.
Offer a fasting plasma glucose test
6–13 weeks after the birth to exclude diabetes
If a fasting plasma glucose test has
not been performed by 13 weeks, offer a fasting plasma glucose test,
or an HbA1c test if a fasting plasma glucose test is not possible, after
Offer an annual HbA1c test to women who
were diagnosed with gestational diabetes who have a negative postnatal
test for diabetes. This was new in the 2015 NICE guidelines.
Aim & Objectives:
The aim was to identify
patients coded with ‘Gestational Diabetes Mellitus’ in our records over last 5
years & search through the parameters to ensure that they have had appropriate
follow up in primary care (and secondary care if appropriate).
One of the primary end points
was to ensure that they have had post- partum check between 6-13 weeks &
have had the annual HbA1C as recommended by NICE. Though this was new in the
2015 guidelines, we as a diabetic team unit agreed to invite everyone with a
GDM diagnosis in the last 5 years for a HbA1C check if they hadn’t had one
Criteria and standard
Though there are no national
guidelines or criteria to measure our audit results against, we (as the
diabetic team for our practice) decided set our own internal standards.
It was decided that ideal
standards for follow-up & meeting the above end-points should be set at 100%
to ascertain we provide a good quality of care to these patients.