Gestational diabetes

New approaches needed for for GDM: position statement

A/Prof Glynis Ross

A dramatic increase in gestational diabetes is threatening to overwhelm healthcare services and needs to be addressed with more resources and a Medicare item for diabetes education, advocacy groups say.

Up to 500,000 Australian women are expected to develop gestational diabetes in the next decade, according to a new Position Statement released by Diabetes Australia, the Australian Diabetes Educators Association and the Australian Diabetes Society

The increase is being driven not just by changes to how GDM is diagnosed but also by increasing rates of weight gain and older age in pregnancy, the groups say.

And as well as a higher risk of antenatal and postnatal complications, GDM also increases the  risk of type 2 diabetes for both mother and baby later in life, it warns.

“Many of these factors are non-modifiable but there are a number of things we can do to help ensure pregnant women are in the best shape possible to reduce their risk of developing the condition,” says Associate Professor Glynis Ross, endocrinologist at Royal Prince Alfred Hospital Sydney and President of the Australian Diabetes Society.

“This could include ensuring all pregnant women can access dietetic support from dietitians with expertise in pregnancy,” she says.

“Women with gestational diabetes need intensive nutrition and glucose management to avoid serious problems. With the best possible management and care, the risks can be reduced, and women can avoid complications.”

The position statement warns that maternity hospitals and diabetes services simply cannot keep up with the increasing numbers of women with GDM.

“The increasing demand is leading to delays in commencing management of GDM in some services, and care being delivered by clinicians who lack appropriate training and expertise in GDM,” it states.

The position statement notes that women with GDM often lack access to support from dietitians for managing blood glucose levels and also fail to have timely access to essential diabetes education.

“GDM education and care is not covered by Medicare or by many private health insurance funds. This means many women receiving pregnancy care in the private sector either pay private practitioners or, if they are unable to meet these costs, try to access services through an already over-burdened public system. Some women with GDM miss out on diabetes education altogether.”

The statement calls for a new Medicare item for women with GDM to support credentialled diabetes educators, accredited practising dietitians and other allied health professionals in delivering essential GDM services.

And despite a National Gestational Diabetes Register, postnatal care of women is often inconsistent and fragmented, the statement notes.

“A clear support and referral pathway for the coordinated postnatal care of women with GDM is necessary. The National Gestational Diabetes Register and follow up system could be further enhanced to better connect clinical and primary care services for women.

“Other initiatives such as general practice incentives and improved access to allied health services through Medicare could improve the delivery of postnatal follow-up screening and care.”

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