Discrepancy between postnatal and antenatal management of gestational diabetes in the U.K.

T here has been no consensus for screening methodology, diagnosis, and management of gestational diabetes mellitus (GDM). We aimed to evaluate routine practice for GDM management across the U.K., including postnatal care. Questionnaires were sent to all members of the Association of British Clinical Diabe-tologists. They were asked to describe how patients were screened for GDM, the diagnostic criteria, and subsequent management and clinical targets, as well as postnatal care. Centers that did not initially respond were followed up by personal communication. Regional variability trends were assessed by subdividing the U.K. into 10 regions and then analyzing the data with the StatXact ␹ 2 test (version 4; Cytel Software , Cambridge, Massachusetts), which has the ability to evaluate associations in two-way tables where there are small frequencies. In addition to providing an indication whether there is a trend in the variability in practice across the U.K., comparing the responses from individual regions also provided an indirect validation surrogate. The response rate averaged 46% nationally (35– 67%). Most (85%) units had a joint clinic, regardless of the size. Most (82%) centers routinely screened for GDM, one-half doing so universally and one-half screening high-risk pregnancies only. Screening tests, cutoff values, timings , and subsequent action varied widely. The first screening test to be used varied, with 40% using glycosuria, followed by random plasma glucose (28%), high-risk features (11%), and fasting plasma glucose (6%). Cutoff values for random and plasma glucose were variable. The 75-g oral glucose tolerance test was the most likely confirmatory test to be used if initial screening is positive; however , clinicians relied on different cutoff values and timing. Most (95%) centers routinely assessed fetal growth. Postpartum screening was under-taken by 90% of centers, using a 75-g oral glucose tolerance test (93%). Most (90%) centers counsel patients about their high risk for further GDM and type 2 diabetes. Despite the significant variability of antenatal screening and management, postna-tal care of GDM was more consistent. Regional variability trends could not be detected between different regions in the UK. One potential limitation of the survey is the small (2%) proportion of questionnaires completed by obstetri-cians. However, as proven from the survey , in the U.K. most (85%) centers run joint clinics with both obstetrics and diabetes teams in partnership, with jointly agreed guidelines. Our report confirms the wide variability in practice across the U.K., in contrast with the U.S., where it …