Five Year Audit of Peripartum Blood Glucose Control in Type 1 Diabetic Patients

Njenga, E.; Lind, Thomas; Taylor, Roy

doi:10.1111/j.1464-5491.1992.tb01840.x

Cited by 21 publications

(6 citation statements)

References 7 publications

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“…30 Some studies have reported a reduction in maternal hypoglycaemia from 40% to 22.2% when the target CBG is relaxed. 39,40 This is similar to the minor maternal hypoglycaemia noted in our study which was promptly and easily treated. The low incidence of hypoglycaemia in the current study in spite of a tight target of 4-7 mmol/L, even in women with VRIII, is reassuring and may be partly because of more monitoring and effective adjustment of glucose and insulin arms of infusion by the staff, but requires more resources.…”

Section: Use Of Vriiisupporting

confidence: 87%

A service evaluation of the impact of adoption of JBDS guidelines for the management of glucose during labour and birth in women with diabetes

Dashora

Ahmed²,

Bossman³

et al. 2021

Br J Diabetes

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Aims: The aim of this retrospective observational study was to report on the impact of adopting the Joint British Diabetes Society for Inpatients (JBDS-IP) guidelines on the achievement of targets recommended by the National Institute for Health and Care Excellence (NICE) and the maternal and neonatal outcomes.Methods: We analysed case records of pregnant women with diabetes who delivered in the period between November 2017 and October 2018 from our data base ‘Euroking’ (Wellbeing Software Ltd, Mansfield). Data were collected in relation to the availability of a dedicated prescription chart in the notes, capillary blood glucose (CBG) monitoring, use of variable rate intravenous insulin infusion (VRIII), maintenance of CBG targets within 4.0–7.0 mmol/L, maternal hypoglycaemia during labour when on VRIII and neonatal hypoglycaemia.Results: Sixty women with diabetes in our database delivered during this period. Thirty-six (60%) were monitored with hourly CBG monitoring and 30 (50%) achieved CBG levels within the NICE recommended target range. Only five women (8.3%) were started on VRIII. There was no maternal hypoglycaemia in the VRIII group. One baby (1.7%) developed mild neonatal hypoglycaemia.Conclusion: Adoption of JBDS guidelines contributed to 60% of women with diabetes receiving complete CBG monitoring, of whom 70% achieved the NICE recommended target of 4.0–7.0 mmol/L during labour and birth. Repeat CBG measurements before starting VRIII, strict adherence to clear JBDS guidelines and protocols, daily review by the diabetes team during the working week and appropriate use of VRIII was associated with good maternal and neonatal outcomes.

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Section: Use Of Vriiisupporting

confidence: 87%

A service evaluation of the impact of adoption of JBDS guidelines for the management of glucose during labour and birth in women with diabetes

Dashora

Ahmed²,

Bossman³

et al. 2021

Br J Diabetes

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“…The study was possible as Newcastle upon Tyne has a long-established photographic retinal screening system [8][9][10][11] and a database recording diabetes care in pregnancy [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Influence of pregnancy on long-term progression of retinopathy in patients with type 1 diabetes

Arun

Taylor

2008

Diabetologia

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Aims/hypothesis Pregnancy in type 1 diabetic women is associated with risk of worsening of retinopathy. It has been reported that deterioration continues in the months after delivery, but direct data are lacking. It is also unclear what impact pregnancy has on the long-term progression of retinopathy. Methods We studied 59 women with type 1 diabetes who had retinal photographs before pregnancy and yearly for 5 years post pregnancy. These photographs were graded using the EURODIAB retinopathy grading system. Results The mean duration of diabetes was 14.4±8.2 years and mean age at pregnancy was 29.8±5.5 years. Mean HbA 1c was 8.2±2.0% before pregnancy with tighter control during pregnancy itself. This value was high despite efforts to improve take-up of pre-conception care. Mean HbA 1c was 8.6±1.5 during the follow-up period. At baseline, 43 (72.9%) women were free of retinopathy, 15 had nonproliferative retinopathy and one woman had previously had laser therapy. During pregnancy four women required laser therapy. Over the next 5 years none required laser therapy, although retinopathy worsened in 14 women. Tenyear follow-up data were available on 22 women, one of whom required laser therapy 8 years after pregnancy. Baseline retinopathy status was the only independent risk factor which predicted progression of retinopathy. Conclusions/interpretation Pregnancy is not associated with post-partum worsening of retinopathy.

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“…22 Some other studies have reported a reduction in maternal hypoglycaemia from 40% to 22.2% when the target CBG is relaxed. 31,32 A recent editorial in Anaesthesia warns against maternal hypoglycaemia in women on VRIII and suggests targeting capillary blood glucose of 6-8 mmol/L. It may not be unreasonable therefore to relax target CBGs to 4-8 mmol/L or even 6-8 mmol/L where hypoglycaemia can have disastrous consequences.…”

Section: Discussionmentioning

confidence: 99%

The feasibility and impact of implementing NICE guidance on diabetes control during delivery

et al. 2017

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Aims: The aim of this study was to report on the practicality, feasibility and impact of implementing the National Institute for Health and Care Excellence (NICE) guidelines for the control of diabetes in women during labour and birth. Methods: We analysed case records of pregnant women with diabetes who delivered in the period between July 2014 and June 2015. The data were collected in relation to the availability of a plan in the notes, capillary blood glucose (CBG) monitoring, use of variable rate intravenous insulin infusion (VRIII), maintenance of CBG targets within 4-7 mmol/L, maternal hypoglycaemia during labour and neonatal hypoglycaemia. Results: Fifty-one women with diabetes delivered during this period. Only 45% of women were monitored by complete hourly CBGs until delivery. 27.4% of women had CBG ≥7 mmol/L but only 17.6% were started on VRIII. The VRIII group had a 22.2% incidence of minor maternal hypoglycaemia. Neonatal hypoglycaemia occurred in 47% of the babies. Conclusion: A CBG target of 4-7 mmol/L during labour and initiation of VRIII when levels are above this target in pregnant women with diabetes is difficult to achieve and is associated with some maternal hypoglycaemia. Repeat CBG measurements within half an hour and strict adherence to clear guidelines and protocols supported by more education and adequate staffing may improve results.Br J Diabetes 2017;17:ONLINE AHEAD OF PUBLICATION

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Five Year Audit of Peripartum Blood Glucose Control in Type 1 Diabetic Patients

Cited by 21 publications

References 7 publications

A service evaluation of the impact of adoption of JBDS guidelines for the management of glucose during labour and birth in women with diabetes

A service evaluation of the impact of adoption of JBDS guidelines for the management of glucose during labour and birth in women with diabetes

Influence of pregnancy on long-term progression of retinopathy in patients with type 1 diabetes

The feasibility and impact of implementing NICE guidance on diabetes control during delivery

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