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Follow-up of women with gestational diabetes in England
  1. MB Pierce1,2,
  2. J Modder3,
  3. I Mortagy3,
  4. H Hughes3,
  5. A Springett3,
  6. S Baldeweg2
  1. 1MRC Unit for lifelong Health and Ageing, London, UK
  2. 2University College, London, UK
  3. 3Centre for Maternal and Child Enquiries, London, UK

Abstract

Women with gestational diabetes (GDM) are managed by primary and secondary care. National Institute for Health and Clinical Excellence (NICE) recommends these women have a fasting blood glucose 6 weeks postnatally (short-term follow-up), and annually thereafter (long-term follow-up).

Aim To describe the practice of consultant obstetricians and diabetologists and general practitioners (GPs) caring for women with GDM in England.

Method Postal questionnaires were sent to one obstetrician and one diabetologist in all obstetric units, and to a random 1/5 GPs in England, in 2008.

Results Response rate: 165/177 obstetricians and 164/177 diabetologists (93%) and 915/1532 (60%) GPs. Although 70% of consultants had a GDM follow-up protocol only 8% had agreed that with primary care.

Short-term Follow-up The venue for the 6-week post natal check was variable – 50% hospital, 31% GP, 17% either. 98% of consultants reported a test of glycaemic control performed 6-week post partum – 82% glucose tolerance test, 13% fasting plasma glucose. There was confusion about who was responsible for ordering this test. 89% of consultants' thought secondary care was responsible, but 44% of GPs thought that they were responsible for ordering the test.

Long-term Follow-up Only 31% diabetologists, 15% of obstetricians asked GPs to follow-up women long-term, but 39% of GPs systematically recalled these women.

Conclusion The follow-up of women with GDM is inconsistent. Responsibility for short-term follow-up and type of test to use is unclear. GPs' views accord better than consultants' with NICE guidelines. Systematic long-term follow-up is being done by a minority of GPs and not encouraged by most consultants.

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