Alison Barry GESTATIONAL DIABETES FORUM

Gestational Diabetes Mellitus

Diabetes Education

Objectives• GDM rates in Metro South• Components of diabetes education

plan specific to women with GDM• Resources available• Barriers and challenges• Benefits of multidisciplinary approach• GP engagement

GDM

GDM in QLD

All QLD HHS

0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%

2006 2007 2008 2009 2010 2011Rate

s of G

DM a

mon

g pr

egna

nt

wom

en

GDM diagnosisReport released from RANZCOG have endorsed new diagnostic criteria – 2 weeks ago

July 2014 – 28/40 universal OGTT

Cease to offer 50g GCT

To be adopted no later than 01.01.2015

RANZCOG – Michael Permezel - President

GTTDiagnosis

Current NewFasting <5.5 <5.1

1 hour <11 unreported in some labs

<10

2 hours <8.0 <8.5

Differs at individual health centresTarget Blood Glucose Levels

OLD NEWFASTING <5.5 mmol/L <5.0 mmol/L

1 HOUR <8.0mmol/L <7.4mmol/L

2 HOUR <7.8mmol/L <6.7mmol/L

Diabetes EducationFollowing diagnosis -> education is vitalOptimal -> within 1/52 of diagnosisReduce maternal anxietyCorrect information – up to dateEncourage partner or support person to attendChallenge of working within a limited timeframe

Key Components of Education• Overview of Gestational Diabetes• Implications for mother and baby• Home blood glucose monitoring (HBGM)

or (SBGM)• Review by Dietitian• NDSS – National Diabetes supplies

scheme• Obstetric assessment• Medical assessment

• DVD – Diabetes Australia• Brochures/Pamphlets• Demonstration• Useful websites eg ADIPS, DA, ADEA,

You2 connect• Must be culturally appropriate.

Education Tools

Blood glucose monitoring• Arrange use of meter – free of charge scheme• Demonstrate use of meter• Lancet / finger pricking device• Record book• Disposal of sharps• Sites for performing tests• Timing of tests – ie QID -Before breakfast & 1 or 2 hrs after each main meal – refer to local protocols

• Recognised as important adjunct therapy

• Appropriate for pregnancy• Eg walking, swimming, pregnastic,

water aerobics• Recommended in absence of

obstetric & medical complications• Culturally appropriate

Physical Activity

Insulin Therapy• Decision made by treating doctor• Based on BSL’s, gestation and clinical evidence

eg SGA or LGA baby• Individual education session• Dose• Device• Injection Sites• Injection Technique• Timing of injections• Disposal of sharps• Management of hypo’s

Metformin• Studies conducted in Aust and NZ to

assess safety and efficacy of use during pregnancy

• MiG study• Follow up studies on offspring• Increased usage since MiG study

Insulin & Metformin Translations

Arabic PunjabiBengali Simple ChineseFarsi TamilFilipino ThaiHindu Traditional ChineseJuba TurkishVietnamese

Insulin TherapyArabic

Insulin & Metformin Translations

Arabic PunjabiBegali Simple ChineseFarsi TamilFilipino ThaiHindu Traditional ChineseJuba TurkishVietnamese

Metformin Bengali

• Vital• GTT – 6 - 8 weeks postnatally• Follow up by dietitian• Follow up by midwife• Discuss – lifestyle issues, weight

management, diet, exercise, future pregnancy, contraception

• Annual fasting glucose with GP

Post natal follow up

Alerts• Need to look at the whole picture• Sometimes clinical scenario doesn’t match

GDM• What to consider• BGL – good glycaemic control• Self reported dietary modifications and

increased physical activity• Clinically LGA• Significant maternal weight gain• USS – fetal macrosomia

Meter downloaded

• Normal pathway now altered• Heightened anxiety and stress at

diagnosis• Impedes ability to learn• Guilt• Concern for baby• Potential separation from baby at birth• Will my baby have diabetes?

Psychosocial Issues

Management• Full explanation of GDM• Implications for pregnancy• Regular contact with specialist team• Ensure plan for birth in partnership with woman• Education – management of diabetes during

delivery and postpartum• Routine care during labour• Monitor BGL’s – local protocols• Anticipate shoulder dystocia• Notify Paediatricians. • Neonatal hypoglycaemia – test @ 1,2 & 4 hours.

Useful websitesADIPS – Australasian Diabetes in Pregnancy

Societywww.adips.orgDiabetes Australiawww.diabetesaustralia.com.auYou2 Connectwww.You2.org.au

Conclusion

When a pregnancy is complicated by diabetes a multidisciplinary team approach provides the best care for a mother and her baby to achieve an optimal outcome.

Avoid

Aim to achieve

Healthy mother and baby

Questions & Discussion