Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For a patient diagnosed with gestational diabetes, you should refer them to a specialist for further management in the following circumstances:
- Upon Diagnosis: When a woman is diagnosed with gestational diabetes, offer a review with the joint diabetes and antenatal clinic within 1 week NICE NG3. You should also inform their primary healthcare team NICE NG3.
- Dietitian Referral: All women diagnosed with gestational diabetes should be referred to a dietitian NICE NG3.
- Unmet Blood Glucose Targets: If blood glucose targets are not met with diet and exercise changes within 1 to 2 weeks, metformin should be offered NICE NG3. If metformin is contraindicated or unacceptable, insulin should be offered NICE NG3. If targets are still not met with diet, exercise, and metformin, insulin should be offered as well NICE NG3. These medication adjustments are typically managed by the specialist team.
- High Fasting Plasma Glucose at Diagnosis: For women with a fasting plasma glucose level of 7.0 mmol/litre or above at diagnosis, immediate treatment with insulin (with or without metformin) and diet and exercise changes should be offered NICE NG3.
- Moderate Fasting Plasma Glucose with Complications: For women with a fasting plasma glucose level between 6.0 and 6.9 mmol/litre and complications such as macrosomia or hydramnios, immediate treatment with insulin (with or without metformin) and diet and exercise changes should be considered NICE NG3.
- Complex Insulin Management: For pregnant women on insulin therapy (who do not have type 1 diabetes) who experience problematic severe hypoglycaemia or unstable blood glucose levels despite optimisation efforts, real-time continuous glucose monitoring (rtCGM) may be considered, which requires specialist input from the joint diabetes and antenatal care team NICE NG3.