In 2014 the Australasian Diabetes in Pregnancy Society (ADIPS) endorsed the 2013 World Health Organization criteria for diagnosing Gestational Diabetes Mellitus (GDM). The updated ADIPS consensus guidelines also included other management recommendations. However, there is no recent literature on how GDM is managed in Australia. The aim of this study was to examine the current practices of the GDM multidisciplinary team in Australia.
A 64-item electronic questionnaire was sent to all Queensland Health facilities between May and June 2017, and was available nationally through the Endocrine Society of Australia, Dietitians Association of Australia and Australian Diabetes Educators Association.
Most respondents (n=182) were Diabetes Educators (DE) (30%) or Dietitians (28%), followed by Endocrinologists (14%), Midwives (13%) and Obstetricians (9%). For diagnosing GDM, the ADIPS guidelines were used by most (82%). There was less consistency on guideline use for the management of GDM with less than 20% of respondents (n=32) using the ADIPS guidelines. According to 83% of clinicians, blood glucose levels (BGLs) are the best indicator of whether a woman with GDM should commence pharmacotherapy and fewer (75%) agreed that BGLs should be considered alongside fetal growth and maternal weight gain before deciding on pharmacotherapy. Eighty-nine percent agreed that Medical Nutrition Therapy should be the first line treatment in managing GDM, however, dietitians were less likely to see women for initial education than DEs (83% vs 93%).
While the results of this national survey indicated there is good consensus on how women are diagnosed with GDM, there appears to be variation to how women are managed. It is unclear if this reflects a lack of clarity in the evidence-base for managing GDM or relates to health professional attitudes. The results of this research will guide the development of a novel, nutrition-focused model of care to be trialled in Queensland in 2018.