The model of care at Counties Manukau Diabetes in Pregnancy service is set up to offer equal access & care to women with GDM, T1 & T2 Diabetes although the patient risk is variable depending on diabetes type. This model of care is not sustainable in its current form. We see an average of a 1000 women every year.There is limited number of Physician FTE available to meet patient demand and a high proportion of time was spent on women with lower risk GDM.
An initiative called the OLGDM pathway ( obstetrician led gestational diabetes management )was launched to re-prioritise resources to cope with the increasingly overburdened DiP( Diabetes In Pregnancy ) service, allowing all patients to be seen and managed in a timely manner without subjecting patients to the high probability of prolonged waiting times during clinic days, resulting from the unavoidable high patient-to-endocrinologist ratio per booked clinic session. This pathway was written so that Patients receiving initial care under the OLG pathway would not be disadvantaged in any way and importantly, any patient who develops (or after initial assessment, be deemed to have) an indication to move across to usual care , can be transferred across seamlessly as indicated.
This was started in Sept 2020. Since then the demand for clinic now meets the need, there are shorter waiting times for women, physicians are able to see the higher risk women in a more timely manner and patient satisfaction with the clinic is improved.
An OLGDM guideline and pathway document was written to start this process. The referrals are triaged based on this and the initial appointment is made for obstetrician only. Training, teaching and mentoring is provided to enable obstetricians and trainees to up skill in the management of gestational diabetes including starting and titrating Metformin and starting Insulin during pregnancy when indicated.
The benefits have translated to improved confidence in Obstetricians and trainee obstetricians who are then able to use this knowledge when seeing women as inpatients and in labour and post partum.
With the population rates of diabetes and prediabetes in the predominantly Pacifika, Maori and Indian population in our catchment area it has become apparent that all clinicians need to feel comfortable in the management of diabetes in pregnancy rather than a select few. Novel models of care are needed to meet growing needs and this is one of them.