Conference hears diabetes care concerns
Postpartum care following gestational diabetes and amputation rates slammed
Friday, 15 March 2013
Just 13 per cent of women who have had gestational diabetes receive blood glucose tests after birth, leaving them at risk of developing Type 2 diabetes, says new research.
Researchers from the University of Surrey, speaking yesterday at the Diabetes UK Professional Conference, used data on nearly 800 women with gestational diabetes from GP practices across England.
It found that only 102 (13 per cent) women were recorded as having received one or more blood glucose tests following the delivery, as recommended by national guidelines.
This conflicts with guidance from the National Institute for Health and Clinical Excellence (NICE) which recommends that women who have had gestational diabetes are monitored post-birth by receiving blood glucose tests six weeks after delivery and then annually.
Gestational diabetes affects around 3.5 per cent of pregnancies in England and Wales. It usually occurs in the second trimester of pregnancy and in most cases can be controlled through diet. Following delivery, women with gestational diabetes are at increased risk of developing Type 2 diabetes, most commonly in the first five years after the birth.
Results showed that for those women whose blood glucose levels were tested, eight per cent were outside of normal levels, two per cent of women had developed Type 2 diabetes and six per cent showed signs of prediabetes.
The researchers recommend compiling a gestational diabetes recall register, setting up computer alerts to facilitate annual recall and the inclusion of screening in pay-for-performance program targets, such as the Quality and Outcomes Framework.
Lead researcher Dr Andrew McGovern said: “The short-term follow up of women with gestational diabetes appears to be haphazard with no set date of recall, which goes against national guidance. There are a number of strategies which could be implemented in primary care to ensure that women are not left at unnecessary risk of developing Type 2 diabetes.
“This study shows the power of using electronic records to identify gaps in quality, especially in primary care. These same records could be used to create recalls and reminders to close this quality gap and make sure that women receive the care they need.”
The conference also heard that white men living in poorer areas have the highest risk of diabetes-related amputation.
The study, led by the Yorkshire and Humber Public Health Observatory and carried out by researchers across the UK, looked at data from 1.8 million people with diabetes in the National Diabetes Audit and found that being male; living in poorer areas; and being white were all associated with a higher risk of lower limb amputation.
There are 6,000 diabetes-related amputations in England every year, which is why it is vital that everyone with diabetes, whatever their background, looks after their feet and manage their condition. But the latest findings suggest it is especially important to get across the message to white men living in poorer areas that they:
- should have a foot check at least once a year;
- be told of their risk of foot problems;
- be aware they need to visit a healthcare professional immediately if there are any problems with their feet.
Too often, people will only see a healthcare professional about their feet once it is already too late. Up to 80 per cent of diabetes-related amputations are thought to be preventable and foot problems not being treated quickly enough is one of the main reasons there are so many unnecessary amputations.
Naomi Holman, the Yorkshire and Humber Public Health Observatory researcher who led the study, said: “It is important that everyone with diabetes takes good care of their feet. While we do not fully understand why white men living in poorer areas have a higher risk of diabetes-related amputation, our findings suggest that efforts to reduce amputations should focus particularly on this group.