Diabetes in Pregnancy (DIP) is associated with substantial rates of maternal and peri natal complications with rising prevalence. This paper presents the findings of a retrospective multidisciplinary clinical audit encompassing aspects of patient care, processes and services focused on the effectiveness of current diagnosis and testing methodologies. The final study after exclusion criteria was applied, consisted of 34 women (8.4% with a 95 % confidence interval and 10% margin of error) who were diagnosed, treated and delivered in 2011 at the Mt Isa Hospital and Health Service. Specific evidence based indicators linked to population, diagnosis/service endpoints, outcomes and complications were collected, collated and analysed.
• Of those reviewed, 90% achieved an HbA1C below 7%.
• Mothers with pre-existing diabetes, and their babies, were at highest risk of adverse event
• Mothers with GDM were at highest risk of induced labour and were more likely to have a pre-term birth, caesarean section, and longer hospital stay than mothers without diabetes in pregnancy.
The paper also presents the potential impact of practice changes required with the introduction of the Australian Diabetes in Pregnancy Society (ADIPS) (Australasian Diabetes in Pregnancy Society 2012) Draft Consensus Guidelines for the Testing and Diagnosis of Gestational Diabetes Mellitus in Australia. The data indicates that a further 5% would have been diagnosed as GDM under the new ADIPS diagnostic criteria. Also, the new ICD-10 2011 clinical coding definitions effective from July 2012 will result in increased surveillance of women with DIP/GDM.
A number of clinical and administrative changes are recommended. Specific monitoring for women with Type 1, Type 2 and “overt diabetes” including fundoscopy, HbA1C and renal monitoring is essential. Increased diligence is required in ensuing post delivery OGTT and lifestyle changes occur.