Background: Gestational diabetes (GDM) affects approximately 10% of the Australian population. Management of GDM through public hospitals alone is not practical due to limited resources. There is a paucity of data of private models of GDM care.
Aims: This is the first report of results of an evidence-based program in a private GDM clinic in Australia.
Methods: Retrospective review of de-identified data for all women with GDM, and their babies, admitted for confinement to a Sydney private hospital from Feb 2015 to Aug 2016. We compared women who underwent treatment with Sydney Endocrinology (SE) to those whose GDM was managed privately or publically elsewhere. The SE multidisciplinary GDM clinic was founded with funding from a Friends of the Mater grant.
Results: Of 3800 births 390 babies were born to mothers with a history of GDM. Of these, 177 were managed through SE. The SE protocol includes an initial one-on-one multidisciplinary review with an endocrinologist, dietitian and diabetes educator, then weekly email contact, and further visits as required. Where possible, there is direct liaison with the patients obstetrician and midwife.
SE patients did not differ from non-SE patients in age (34.9 vs 34.6 years), BMI (24.0 vs 24.1 kg/m2), or ethnicity (all p=NS). There was no increase in the odds of elective or emergency Caesarian section (p=0.49, chi squared test for trend, Newcombe-Wilson method). SE patients had in increased odds of insulin and/or metformin prescription (49% vs 35%, respectively, OR 1.8, 95% CI 1.2-2.7, p=0.005).
The SE babies did not differ from non-SE babies in gestational age at birth (mean 38.3 vs 38.2 weeks, respectively), weight (3177 +/- 519g vs 3238+/-477g, respectively), length (mean 50.6 vs 50.8 cm, respectively) or head circumference (all p=NS). There was a lower rate of special care nursery (SCN) admission for SE vs non-SE patients (23% vs 32%, respectively, OR 0.62, 95% CI 0.40-0.97, p=0.04). Similarly there were lower rates of hypoglycaemia (defined as <=2.5mmol/L, 36% vs 48%, respectively, OR 0.61, 95%CI 0.41-0.92, p=0.02). There was no difference in the mean lowest glucose of those that suffered hypoglycaemia in each group (2.0 vs 2.0 mmol/L, p=NS), rates of jaundice (32% vs 29%, p=0.7), nor foetal anormality (7.3% vs 7.0%, p=0.8).
Discussion: In the private health care setting, GDM patients managed through a individualised multidisciplinary system with protocolised frequent follow-up are less likely to require SCN admission. This is likely related to more frequent initiation of insulin therapy, and is not associated with increased rates of neonatal hypoglycaemia, jaundice or malformation. We also postulate this is related to close frequent follow-up of patients, and extensive dietetic coaching and input. Further studies in this area would be useful to confirm these findings.