Alice Springs Hospital has a catchment area of approximately 1.5 million kilometres. This area crosses the state boundaries of South Australia and Western Australia. Our region is notable for its high Aboriginal population, its remoteness and its social disadvantage, with 74% of Aboriginal people assessed as living in the most disadvantaged quartile (1).
A retrospective audit of 794 pregnant women who birthed at the Alice Springs Hospital over a 12 month period from July 2014 to June 2015 was performed. Of the 594 women with analysable data the following results were obtained:-
• 2.8 % of women had Diabetes Mellitus first diagnosed in Pregnancy (DMIP),
• 11.9% had Gestational Diabetes Mellitus (GDM). The adoption of the new GDM criteria (2) had minimal impact on our referral numbers with only two extra women identified over 12 months.
• 6.7% had previously diagnosed Type 2 Diabetes Mellitus (T2DM) and 40% of those had a HbA1c of 8% or greater.
In summary 21.5% of our birthing cohort had some form of DIP - all categories of which were significantly higher than reported national levels (3), especially pre-existing T2DM which was 22 times more common! 95% of those with T2DM were of Aboriginal descent.
Of concern was that 22.5% of women had no record of testing for DIP in their pregnancy and that only 17% of high risk Aboriginal women received the recommended early 75G OGGT. Logistically challenging for our clinic is the fact that the women with more severely deranged glycaemia (T2DM and DMIP) were more likely to be very remote dwelling Aboriginal women.
This study allowed our team to quantify our workload and assess our level of resourcing and models of care required to address the needs of our birthing women.