The current delivery of gestational diabetes care is falling short of patients’ support needs, with improved communication and a more individualised approach to diagnosis and management among the areas requiring attention.
The findings come from a survey of 815 women (mean age 37) who have been receiving gestational diabetes mellitus (GDM) care in Australia within the last five years, who were recruited from a national diabetes registry and via social media.
Published in Diabetic Medicine [link here], the major takeaways include patient frustration at inflexible or inconsistently applied guidelines for diagnosis, blood glucose monitoring and targets, and recommended birth options.
Some patients reported only just being above the diagnosis criteria for GDM but being subjected to what they perceived as overly strict self-management guidelines.
When done well, respondents emphasised the critical role of education by healthcare professionals in supporting their GDM self management. Diabetes education sessions and comprehensive nutrition-related content were particularly valued.
One respondent said: “The nurse … Made sure you understood what was going on, how to use your monitor, plenty of information on foods to eat etc… The dietitian was great, went through what you should be doing and eating in great detail, lots of printed materials to take home to support that.”
However, respondents wanted more education on why they had developed GDM, indicating that this could help reduce feelings of self blame and guilt, as well as more information on how their diagnosis would affect pregnancy and labour.
The importance of receiving genuine and supportive care was also reported.
Respondents highlighted positive experiences around receiving reassurance and acknowledgement, particularly regarding the variations in their blood glucose levels, and appreciated when their efforts were recognised regardless of outcome.
Consistent care was also valued, whereas situations where different healthcare professionals delivered different messages resulted in confusion and angst.
Concerningly, some patients reported feeling judged and blamed by healthcare professions for their GDM diagnosis and/or suboptimal glucose levels, and reported disengagement from clinical care as a result of negative experiences.
One participant said: “The endocrinologists were very condescending when I wasn’t following their recommendations and just made me feel worse. I stopped attending appointments.”
Another reported: “The actual blood tests were not the worst part. It was the judgement I felt from the diabetes team when I made a mistake with what I ate or had an abnormally high reading. I didn’t feel like they were supporting or educating me – I felt like they were judging me.”
The authors concluded that GDM care in Australia could be improved to be more supportive and tailored to the individual, with an emphasis on improved communication and personalised implementation of clinical guidelines.
“These approaches have the potential to alleviate barriers to accessing care and mitigate the negative psychosocial effects associated with GDM, such as emotional strain, stigma, and social isolation,” they wrote.
“While not the primary focus of the findings, digital health technologies may offer supplementary support in optimising GDM care.”