The aim of the audit was to assess the effect on maternal and fetal outcomes of new treatment targets for Gestational Diabetes Mellitus (GDM), as recommended in the 2013 Australian Diabetes in Pregnancy Society (ADIPS) consensus guidelines (1). These new treatment targets were fully implemented in the Sunshine Coast Hospital and Health Service district by December 2016. Further data was collected regarding the subsequent impact on mode of delivery, outpatient resources, and overall healthcare service provision cost.
Medical records of 286 patients with GDM diagnosed in our health service district from December 2016 until May 2017 were retrospectively audited and compared to patients diagnosed between January 2015 and June 2015. We excluded women diagnosed prior to a 24-28 week oral glucose tolerance test and patients who delivered at another facility from statistical analysis.
Data collection is ongoing at time of writing with auditing of 241 charts completed.
Preliminary data comparing the 2015 and 2016/17 cohorts shows an increased proportion of patients requiring treatment for GDM from 20.5% (n=15) to 24.7% (n=25) with metformin, insulin or both. There has been an increase in induction of labour from 27.4% (n=20) to 50.5% (n=50). The incidence of large for gestational age was 9.5% (n=7) vs. 12.1% (n=12) and neonatal hypoglycaemia was 12% (n=9) vs. 14.1% (n=14). Admission to the special care nursery (SCN) was 27% (n=20) vs. 24.2% (n=24) suggestive of slight decrease in admission rate, and there was a corresponding reduction in the median SCN length of stay from 3 days (range 1-15 days) to 2 days (range 1-12 days).
This suggests the new treatment targets may increase induction of labour and perinatal morbidity with limited benefit. A subgroup analysis, cost analysis and discussion regarding contributors and confounders of the observed change in outcomes in our service will be presented.