The easy-to-do audit series: An audit of diabetes screening in women previously diagnosed with gestational diabetes

Gestational diabetes is defined as any degree of glucose intolerance that is first detected during pregnancy (Metzger and Coustan, 1998). For all women who have had diabetes during pregnancy, it is estimated that approximately 87.5% have gestational diabetes (NICE, 2015). Shortly after delivery, glucose homoeostasis is restored to non-pregnancy levels, but some women become at risk of developing type 2 diabetes in the future (Kim et al, 2002; Järvelä et al, 2006), with up to 50% developing type 2 diabetes within 5 years of the birth (NICE, 2015). For any population and ethnic group, the risk of gestational diabetes indicates the underlying frequency of type 2 diabetes (Kim et al, 2002; NICE, 2015).

The incidences of gestational diabetes and type 2 diabetes are rising throughout the world, with huge healthcare and economic costs. There is, thus, an urgent need to put in place interventions that may delay or prevent type 2 diabetes developing in this high-risk population of women. For this reason, NICE (2015) advises that women who are diagnosed with gestational diabetes and whose blood glucose levels return to normal after the birth should be offered a fasting plasma glucose test 6–13 weeks after the birth to exclude diabetes. The guidance, however, recognises that for practical reasons this might take place at the 6-week post-natal check, which is normally conducted by general practitioners in primary care. According to NICE (2015), if the fasting plasma glucose test has not been performed by 13 weeks, it should be offered again. However, if a fasting plasma glucose test is not possible, then an HbA_1c test should be offered instead. For women who are not found to have diabetes at this stage, it is recommended that they are offered an annual HbA_1c test.

Your turn
The instructions on the next page explain how to complete the audit. You can download the full-size audit form at www.diabetesandprimarycare.co.uk/audits to fill in and retain. The audit should take no more than a few hours to complete.  

After you have completed the first data collection, you can send in your top-line aggregated data to
[email protected].

Audit method
This will be a two-step completed audit to be carried out in primary care centres in the UK. The first retrospective data collection from the past 12 months will be done on a selected day between 1^st March and 30^th April. The second data collection will take place 12 months later to allow for appropriate interventions to be put in place at the local or practice level.

Criteria
1. All patients with a gestational diabetes diagnosis should have a fasting blood glucose test at the 6-week postnatal check, any time between 6 and 13 weeks after birth or have an HbA_1c test after 13 weeks (NICE, 2015).

2. All patients with a gestational diabetes diagnosis should be  offered HbA_1c testing annually if they were found not to have diabetes at the 6-week post-natal check (NICE, 2015).

Standards

• For criterion 1, a target of 90% is to be considered to allow for non-attendance, relocation of patients and difficult-to-reach patient groups.

• For criterion 2, a target of 80% is to be considered to allow for non-attendance. A lower target at this stage is considered as it is less likely the patients will attend for the screening without the imperative of a baby check. 

N.B. Set a reminder on the practice’s electronic calendar to repeat the audit as close to the first data collection date 12 months later.

Download the full-size audit form at www.diabetesandprimarycare.co.uk/audits