[CG] COVID 19 Combined Obstetric Diabetic Clinics : Revised plan for diabetes antenatal clinic including contingency plans for gestational diabetes testing

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Objectives

  1. To decrease footfall in hospital ANC’s by conversion to as much remote working as possible
  2. To develop contingencies if problems of supply of glucose meters or ability to perform OGTTs worsens
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General:  while usual (non-pregnant) diabetes clinics are now cancelled for the next few weeks, advice and emergency clinics will be available for pregnant women 

PRM:

  1. At time of usual Tuesday morning antenatal clinic at PRMU which will continue throughout
  2. At other times at least Monday – Friday 9-4 at Stobhill using contact number 0141 355 1078 – in this context if meter/ equipment / insulin problems

QEUH:

  1. Wednesday antenatal will continue-list will be reviewed to determine who needs to be physically seen
  2. Contact details:
    1. North West Glasgow Hub (GGH): [email protected] and mobiles GGH 1 (Consultants) 07943 585890, GGH2 (DSNs)  07943 585907
    2. South Glasgow Hub (QEUH/Victoria) [email protected] and mobiles Vic 1 (Consultants) 07943 585877, Vic 2 (DSNs)  07943 585884

RAH:

  1. Wednesday clinic 11.30 will continue as normal (afternoon clinic under review)
  2. Urgent contact via secretary at 0141 314 6882 in hours or in emergency medical “registrar” 3rd on RAH

A. Conversion to remote working where possible

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

Plan

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

B. GDM

1. Classes with DSN and dietician after diagnosis  – this has previously been managed in group sessions but these are now suspended.

Interim plan for women with new diagnosis of GDM would be

  1. to provide standard video explanation of blood glucose testing (to shorten training by DSN) along with written dietetic advice, eg agamatrix.co.uk/support/videos
  2. Meters provided with final questions on one to one basis by DSN
  3. Remote follow up by DSN and dietitian as needed

2. Antenatal visits – As for pre-existing diabetes.

 

Contingencies for difficulty supplying meters

If there is difficulty in supply of meters or strips, these should be targeted at the following women:

Highest priority:

Women with type 1 or type 2 diabetes (unless using freestyle or continuous glucose monitor). 

Women with diabetes diagnosed in pregnancy who are using insulin

Women diagnosed in pregnancy who have fasting ≥7mmol OR 2 hour ≥11.1mmol/l on OGTT

Next priority:

Women diagnosed in pregnancy who have fasting 6.0-6.9mmol OR 2 hour 10.0-11.0mmol/l on OGTT

Lowest priority:

Women diagnosed in pregnancy who have fasting 5.1 – 5.9mmol OR 2 hour 8.5- 9.9mmol/l on OGTT. 

While not ideal if we are not able to monitor it is still appropriate to give written dietary advice Teams on the ground (DSN’s diabetes consultants) will decide when this is necessary

Last reviewed: 03 April 2020

Next review: 03 April 2021

Version: 4

Approved By: GONEC