Clinics are already adapting this as needed to local circumstance
Pre-existing diabetes in pregnancy
Issues – Women with diabetes at higher risk of pregnancy complications so need regular antenatal assessments
1. Prepregnancy visits – change to phone consultation where possible
2. Antenatal Visits
Visits to obstetric antenatal clinics are either see the diabetic team alone or to have a full antenatal check (often with a scan) and see midwife, obstetrician and diabetologist (team)
If woman coming to see the ‘team’ then they should attend in person.
If woman coming for ‘diabetes only’ then diabetologist should decide whether the next visit requires to be in person ( e.g. starting insulin, starting pump) or could be conducted over the phone ( the majority). TRAK outcome should be completed as either “diabetes in person” OR “diabetes by phone” – in either case the patient should be on the clinic list and be given an appointment time (even if for a phone call). How this is arranged may vary between sites.
Diabetes will make use of the attend anywhere and near-me service.
3. Postnatal OGTT– these should be cancelled and rearranged at a later date.
4. Access to home glucose monitoring results remotely -
Women with type 1 diabetes: most should be using freestyle libre and should be encouraged to share their data with the diabetes team using Libre view (or similar systems for continuous glucose monitoring). Most women are now using this system.
Women with type 2 diabetes: the diabetes MCN has allowed for use of freestyle libre in these patients- particularly where intensive insulin regimens used or are expected. This should facilitate remote contact as above
Gestational diabetes: some glucose meters have Bluetooth capability and teams are exploring use of these along with either meter specific software or diasend to facilitate data sharing with the diabetes team. For some meters (agamatrix) an additional letter explaining need to prescribe these strips will be needed)
If there are problems with supply of meters or testing strips at any stage then see contingency B