Abstract
In order to establish reasons for an unexpectedly low referral of only six women in one year with gestational diabetes (GDM) to the combined diabetic‐antenatal clinic in a hospital with 35% Indo‐Asian population, an audit of adherence to the locally‐agreed policy of screening by clinical risk factors was undertaken. One hundred and forty three case records (3.6%) for deliveries in 1993 (100 for Europid and 43 for Indo‐Asian women) were examined for the documented presence at booking and for the subsequent development of traditional obstetric risk factors for diabetes. The number of women with one or more risk factors who had taken an oral glucose tolerance test (OGTT) was recorded.
Fifty three (37%) women (33 [33%] Europid and 20 [46.5%] Indo‐Asian) had one or more risk factors of whom ten (7%) women had taken an OGTT. Three women had abnormal glucose tolerance: one was referred to the combined diabetic‐antenatal clinic. It was concluded that poor adherence to the locally‐agreed policy of screening for diabetes in pregnancy explained in part the low rate of detection and referral. Since 1994, gestational diabetes has been included in the curriculum for the education programme for trainee doctors in obstetrics and gynaecology, and screening according to risk factors was recommended to them.
The results of the first audit were presented to the Directorate of Obstetrics and circulated to all clinicians. A repeat audit was performed in 1995. One hundred and forty‐seven case records (3.7%) were examined (95 for Europid and 52 for Indo‐Asian women). Seventy (48%) women (44 [46%] Europid and 26 [50%] Indo‐Asian) had one or more risk factors for diabetes, of whom 20 (29%) had received an OGTT. This indicated no significant improvement in compliance with the guidelines (p=0.30). We conclude that education directed at clinicians was not effective in improving the detection of GDM in a population at high risk.