All pregnant women with type 1 diabetes are to be offered use of continuous glucose monitoring (CGM) from April 2020 to improve the health outcome of births.
The drive to increase use of CGM for mothers to be with type 1 diabetes forms one of the key aims laid out within the National Pregnancy in Diabetes (NPID) Audit of 2018, which is published today.
The audit is a report on a wide range of aspects of care for pregnant women with diabetes. The report notes that complications within pregnancy remain high for women with diabetes in comparison to women without. Stillbirth, neonatal death, congenital anomalies, and large or small babies are some of the problems that are more likely to occur in pregnant women that have diabetes.
The recommendations, detailed within the audit, to improve outcomes include greater empowerment for women to make self-management decisions and increases in training for healthcare professionals.
Recent research has shown CGM to provide significant benefit in improving pregnancy outcomes and NHS England’s 10-year plan is committed to offering CGM to all pregnant women with type 1 diabetes from April 2020.
Lucy Schonegevel, patient representative of the NPID Advisory Group, states in the report: “It’s fantastic that continuous glucose monitoring will be rolled out for women in England with type 1 next year and a huge well done to the NPID team for the role played in achieving that.”
Lucy added that this is one part of the picture and that there are additional opportunities for improvement: “But there are also longer term changes that need to be made around education, such as introducing further structured education ‘add-ons’ for pregnancy to help women learn tools to take control of their ever-changing insulin requirements.
“Also, looking at health professional education as well and how they can make the most of the introduction of CGMs to support women to make day to day decisions.”
The audit shows that, for the first time in the audit’s history, pregnancy in women with type 2 diabetes is more common than type 1 diabetes. Type 2 diabetes represented 51% of the pregnancies within the audit. This compares with type 1 diabetes which represented 47% of the pregnancies.
Women with type 1 diabetes were more likely to have HbA1c levels of 48 mmol/mol (6.5%) or above than women with type 2 diabetes. Full-term babies born to mothers with type 1 were more likely to be admitted to neonatal units than the babies of mothers with type 2. Stillbirth rates were higher when mothers had type 2 diabetes compared with type 1.
The audit notes that the greater risks of complications in pregnancy for women with diabetes has not changed over five years of NPID measurement and ‘step-changes’ to improve outcomes are needed.