QJM Advance Access published online on August 18, 2008
QJM, doi:10.1093/qjmed/hcn069
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Gestational diabetes screening and glycaemic management; National survey on behalf of the Association of British Clinical Diabetologists
From the 1University Hospital of North Staffordshire, Stoke-on-Trent ST2 6QG, UK, 2University Hospital of Wales, Cardiff, UK, 3Prince Charles Hospital, Merthyr Tydfil, UK and 4Keele University, Stoke-on-Trent, UK
Address correspondence to Dr F.W.F. Hanna, Consultant Physician & Endocrinologist, University Hospital of North Staffordshire, Stoke-on-Trent ST2 6QG, UK. email: fahmy.hanna{at}uhns.nhs.uk
Received 30 January 2008 and in revised form 18 March 2008
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Abstract |
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Background: There is no UK consensus for screening methodology, diagnosis and management of gestational diabetes mellitus (GDM).
Aim: To evaluate routine practice for GDM management across the UK.
Methods: Questionnaires were sent to all members of the Association of British Clinical Diabetologists. They were asked to describe how patients were screened for GDM, the diagnostic criteria and subsequent management and clinical targets. Centres that did not respond were followed up by personal communication. Variability trends within regions were assessed.
Results: The response rate averaged 46% nationally (35–67%). Most (85%) units hold a joint clinic, regardless of the size. Most (82%) centres routinely screen for GDM; half universally and half screening high risk pregnancies only. Screening tests, cut-off values, timings and subsequent action vary widely. The first screening test to be used varies, with 40% using glycosuria, followed by random plasma glucose (RPG)(28%), high risk features (11%) then FPG in 6%. Cut-off values for both random and plasma glucose as screening methods also vary. The 75 g oral glucose tolerance test (OGTT) is the most likely confirmatory test to be used if initial screening is positive; however, clinicians rely on different cut-off values and timing. Most (95%) centres routinely assess foetal growth. Postpartum screening is undertaken by 90%, using a 75 g OGTT (93%). Most (90%) centres counsel patients about their high risk for further GDM and type 2 diabetes mellitus. Variability trends in any of the responses could not be detected between different regions in the UK.
Conclusion: Standards for GDM screening and management vary significantly across the UK. Although most centres utilize the 75 g OGTT to confirm the diagnosis, there is no consistency in its interpretation. This survey confirms the urgent need for consensus guideline development.