Poster Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2019

Reduction in pregnancy risk among young women with diabetes in a transition diabetes clinic (#63)

Uchechukwu L Osuagwu 1 , Akhil Gupta 2 3 , Manjula Ratnaweera 4 , David Simmons 1
  1. School of Medicine, Diabetes, Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, Campbelltown, South Western Sydney, NSW 2560, Australia
  2. Flinders Medical Center , Flinders University, Bedford Park, South Australia, NSW, Australia
  3. Medicine, Western Sydney University, Campbelltown, NSW, Australia
  4. Diabetes, Waikato Hospital , Hamilton , New Zealand

Objective: To compare the management of young adult women with diabetes attending a transition service before and after revised clinic processes

Methods: Repeat audit of young women aged 17–25 years with type 1 and type 2 diabetes before (audit one, 2012-2016) and after (audit two, 2017- 2018) the introduction of a proforma: documentation of contraception uptake, provision of educational materials from the local Diabetes Contraception and Pre-Pregnancy Programme (DCAPP), reserved waiting area space, a second diabetes educator and early evening clinic slots in a tertiary hospital diabetes transition clinic. Data for routine monitoring of pregnancy care and hospital admissions for hypoglycaemia or diabetes ketoacidosis; recorded measures of glycated haemoglobin (HbA1c), body mass index (BMI), and mental issues were collected and analysed.

Results: 47 and 57 women with diabetes in audit one/two, respectively. First attendance mean age (T1DM 19 ± 2 vs 19 ± 1 yrs; T2DM 22 ± 2 vs 20 ± 2 yrs), last BMI (23 ± 5 vs 26 ± 6 kg/m2; 39 ±10 vs 38 ± 6 kg/m2), diabetes duration (12 ± 6 vs 10 ± 6yrs; 7 ± 8 vs 3 ± 4 yrs) and HbA1c (9.5 ± 2.1 vs 9.7 ± 2.4%; 9.7 ± 2.9 vs 10.7 ± 2.9%) were similar between audits. Years attending the clinic (1.9 ± 1.9 vs 2.0 ± 1.5; 0.5 ± 0.5 vs 0.7 ± 1.1) were not significantly different. HbA1c reduction since first attendance was greater in audit two than one, respectively in T1DM (1.2±3.0 vs 0.1±1.8%, P=0.001) and T2DM (1.8±2.0 vs 0.9±2.0%, P =0.047). There were fewer episodes of DKAs (56 vs 15% P<0.001), severe hypoglycaemia (19 vs 2%, P=0.01), fewer pregnancies (19 vs 8%, P=0.03), and higher contraception rates (26 vs 41%, P <0.001) in audit 2. Mental health issues particularly depression (49%) were common in both audits.

Conclusions: Introduction of more proactive approaches to diabetes management including contraception awareness and advice were associated with improved metabolic control and a reduced risk of pregnancy. The high rate of mental health issues, and limited access to psychological support remains a significant problem.