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NICE guideline Diabetes in pregnancy[NG3] to be updated

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NICE are planning to partially update the NICE guideline on diabetes in pregnancy (NG3). The update will focus on the role of continuous glucose monitoring for women with type 1 diabetes who are planning to become pregnant or already pregnant, after considering the results of the landmark CONCEPTT trial.

The CONCEPTT trial found improvements in a range of neonatal outcomes with continuous glucose monitoring plus standard care, compared with standard care alone, and advocates routine usage in pregnant women with type 1 diabetes. This could potentially alter recommendation 1.3.17, which currently advises do not offer continuous glucose monitoring routinely to pregnant women with diabetes

View the reasons and more details on the decision here


NIHR Signal: Fewer large babies are born to pregnant woman with type 1 diabetes if their glucose was monitored continuously

Pregnant women with type 1 diabetes who used a continuous glucose monitoring system were half as likely to have a large baby compared with those using standard finger prick blood glucose measurements. Only 15% of infants needed intensive care admissions due to low blood glucose in the continuous glucose monitoring group, compared with 28% born to mothers in the standard finger prick control group.

Pregnant women using continuous monitoring spent 7% more time in the target glucose range than those on standard measurements. However, their HbA1c levels, which indicate diabetic control over 12 weeks, only improved slightly. This may be unsurprising because HbA1c results are less reliable in pregnancy and women found it hard to stick to the continuous monitoring protocol.

Strict control of blood glucose levels during pregnancy reduces the risk for women with type 1 diabetes, and their babies are less likely to be large or need treatment for low blood glucose. Continuous monitoring provides many readings but requires the user to deliver insulin accordingly. Motivated women may find continuous monitoring helps them manage their glucose levels more closely during pregnancy and reduce both antenatal and postnatal complications.

Read the full signal here

National Pregnancy In Diabetes Annual Report 2016

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Image Source: NHS Digital

The National Pregnancy in Diabetes (NPID) audit is part of the National Diabetes Audit (NDA) programme and is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The NDA is managed by the NHS Digital in partnership with Diabetes UK and is supported by Public Health England (PHE).

The audit is a measurement system to support improvement in the quality of care for women with diabetes who are pregnant or planning pregnancy and seeks to address the three key questions:

– Were women with diabetes adequately prepared for pregnancy?

– Were adverse maternal outcomes during pregnancy minimised?

– Were adverse fetal/infant outcomes minimised?

This report includes data on women with diabetes with completed pregnancies between 1 January 2016 and 31 December 2016.

Almost one in 10 women with Type 1 diabetes had at least one hospital admission for severe hypoglycaemia.

Download the full report here