Introduction

1. 0% 25 Gest referred Gest HBGM started Metformin 20 3 14% Diet 8 15 38% 10 Insulin 10 48% 5 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 35 insulin 30 Metformin 25 20 15 10 5 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Home Blood Glucose Monitoring in Women with Previous History of Gestational Diabetes Saudabi Valappil, Kate Meredith, Meenu Sharma, Catherine Mammen, Prakash Parameswaran Department of Obstetrics and Gynaecology, Pennine Acute Hospitals, NHS Trust, Manchester, UK Aims and Objectives Results Introduction Treatment • Risk of recurrence of Gestational diabetes(GDM) in subsequent pregnancies -38-75% • Ideal method to detect recurrence of GDM ? • Routine GTT at 24-26w • Early GTT at 16-18w • Early home blood glucose monitoring (HBGM) • NICE recommends either early • home blood glucose monitoring • or GTT at 16-18 weeks and if • normal to repeat at 26 w • To evaluate the protocol of early home blood glucose monitoring in women with previous history of GDM in RI • To assess adherence to NICE guideline • To assess the effectiveness of HBGM Gestation at treatment Results summary • All women were referred to diabetes specialist midwife • 19 (76%) referred by 12weeks and all were referred by 17 weeks • HBGM commenced by 14 weeks in 18(72%)women Methods • Retrospective study • Identified 34 women who have had GDM in the past and booked for antenatal care in RI between Aug 2010- April 2011 • Data collected from 25 sets of notes Background • Policy in Royal Oldham Hospital – women referred to diabetes midwife at booking and commenced HBGM • If HBGM normal - GTT at 26 weeks • If HBGM abnormal – Referred to multidisciplinary diabetes clinic Outcome • All women had live birth • One baby had bladder outlet obstruction • 1 admission to SCBU due to prematurity Results • 21(84%) women developed diabetes in current pregnancy • 19 women had abnormal blood sugar profile • In 2 women, GDM detected by GTT at 26w (blood sugar profile was borderline in both) • 3 women required insulin at 12-16w. • 2 were started on metformin at 18w Findings Conclusions • 21 women had previous one pregnancy with GDM • 4 women had 2 or more pregnancies with GDM • 17(68%) women were treated with diet alone in previous pregnancies • All women had live births Advantages • 100% adherence to the guideline • Earlier detection and • treatment in 1 in 5 women • HBGM is an effective tool for earlier detection of GDM or type II diabetes in women with h/o GDM in the past. • Early detection and management of GDM/Type II diabetes • Early encounter with the specialist team • Encourage diet and lifestyle management early