INTRODUCTION: Pregnant women with pre-existing diabetes have increased risk for poor outcomes such as macrosomia, shoulder dystocia, still birth and intrapartum interventions. The Combined Diabetes Antenatal Clinic (CDAC) in Prince Albert (started in 2012) is a multidisciplinary clinic that serves rural northern Saskatchewan where the prevalence of diabetes in pregnancy is high. The goals of the CDAC are to improve euglycemia and pregnancy outcomes. METHODS: Retrospective cohort chart review to quantify the reduction in HbA1c after CDAC interventions and if the reduction in HbA1c improved pregnancy outcomes. Ethics approval was obtained from University of Saskatchewan. RESULTS: We identified 116 CDAC patients with pre-existing diabetes between 2012-2017. Majority of the population (52%) had to travel over 200 km to reach the CDAC clinic. There were high rates of obesity (71%) and high parity (28% Para 4 or more), majority were Type 2 diabetics and 87% of mothers were on insulin at the time of delivery. Women often (75%) presented to the CDAC after the first trimester. However, over 50% of patients who attended the CDAC reached the target of having an HbA1c below 6.5% prior to delivery. Mean change in HbA1c was -1.0% (SD 0.5-2.4) Mothers with HbA1c below 6.5% at the time of delivery had lower rates of shoulder dystocia (5.9% vs 2.3%) and still birth (11.8% vs 4.5%). CONCLUSION: The CDAC is effective in reducing the HbA1c and reductions below 6.5% is associated with improved pregnancy outcomes. We advocate pre-pregnancy counselling and booking early in pregnancy for pre-existing diabetes in this rural population