Oral Presentation Australian Diabetes in Pregnancy Society 2018

Midwife / Diabetes Educator perspective.  View from the trenches…  How are we managing workload issues? (#18)

Janet Lagstrom 1
  1. Diabetes Nurse Practitioner, Yarrawonga, VIC, Australia

The Australian Diabetes Pregnancy Society (ADIPS), first updated the Gestational Diabetes (GDM) guidelines in 1999, over time, implemented around Australia.  Ready for change, ADIPS adopted the consensus guidelines by the International Association of Diabetes and Pregnancy Study Groups (IADPSG, 2010), in 2014. These developed from the growing evidence base for adverse outcomes in pregnancy enhanced by the Hyperglycemia and Adverse Pregnancy Outcome Study (HAPO, 2008).

Four years later, Australia and New Zealand continue to lack uniformity in management of GDM women, stemming from the Royal College of General Practice (2016- 2018) statement “at present, little evidence that clinical intervention is beneficial for the additional women identified by the new screening criteria”, as such has been (mis)interpreted around rural and tertiary Institutions.

Change included:

  • Omission of 1-hour 50g Glucose Challenge Test (GCT): one step diagnosis (less anxiety, however longer test for pregnant women).
  • Lowered FBG diagnostic target (from less than 5.5 to 5.0 mmol/L) (increased women diagnosed and, workload for staff)
  • Additional diagnostic target, 1 hour post 75g load to reduce Caesarean births (should we advise checking 1hour or 2 hour pp for these women)
  • Provision of 2 options whether to commence medication, suggesting Clinicians make own decision rather than use a National Consensus, lending women to receive conflicting advice from GP, CDE, and Birth Venue            

                  (Will women change Birth Venue to avoid insulin initiation)

On behalf of the women we care, I seek consensus:

  • We should develop and use clear terminology
  • We should liaise with our respective Clinical partners (RACGP / RANZCOG/ AAPP)
  • We should develop and use consistent criteria, regardless of site
  • We should be aware of current guidelines

Please share your opinion!

  1. ADIPS (2014), ADIPS consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia. [Online]. Retrieved from: https://adips.org/information-for-health-care-providers-approved.asp
  2. HAPO Collaborative Research Group (2008), Hyperglycemia and adverse pregnancy outcomes. The New England Journal of Medicine, 358: pp. 1991-2002.
  3. IADPSG Consensus Panel (2010), International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy, Diabetes Care, 33: pp. 676-682.
  4. RACGP (2016). RACGP Clinical Guidelines. General practice management of type 2 diabetes. [Online]. Retrieved from: https://www.racgp.org.au/your-practice/guidelines/diabetes/13-diabetes-and-reproductive-health/133-gestational-diabetes-mellitus