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
Rates of GDM among pregnant
women
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
2006
2007
2008
2009
2010
2011
GDM diagnosis
Report 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
GTT
Diagnosis
Fasting
1 hour
2 hours
Current
<5.5
New
<5.1
<11
unreported in some labs
<8.0
<10
<8.5
Differs at individual health centres
OLD
NEW
FASTING
<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 Education
Following diagnosis -> education is vital
Optimal -> within 1/52 of diagnosis
Reduce maternal anxiety
Correct information – up to date
Encourage partner or support person to attend
Challenge 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
Education Tools
DVD – Diabetes Australia
Brochures/Pamphlets
Demonstration
Useful websites eg ADIPS, DA, ADEA, You2
connect
• Must be culturally appropriate.
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Blood glucose monitoring
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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
Physical Activity
• Recognised as important adjunct therapy
• Appropriate for pregnancy
• Eg walking, swimming, pregnastic, water
aerobics
• Recommended in absence of obstetric &
medical complications
• Culturally appropriate
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
Bengali
Farsi
Filipino
Hindu
Juba
Vietnamese
Punjabi
Simple Chinese
Tamil
Thai
Traditional Chinese
Turkish
Insulin Therapy
Arabic
Insulin & Metformin
Translations
Arabic
Begali
Farsi
Filipino
Hindu
Juba
Vietnamese
Punjabi
Simple Chinese
Tamil
Thai
Traditional Chinese
Turkish
Metformin Bengali
Post natal follow up
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
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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
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Meter downloaded
Psychosocial Issues
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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?
Management
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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 websites
ADIPS – Australasian Diabetes in Pregnancy
Society
www.adips.org
Diabetes Australia
www.diabetesaustralia.com.au
You2 Connect
www.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