Background: The Goulburn Valley (GV) Diabetes Centre provides acute and subacute Diabetes care in the Goulburn Valley and surrounds, including Gestational Diabetes Mellitus (GDM) management. The current model of care at GVH is GDM management upon diagnosis with service discharge following delivery. There is no follow-up prevention program currently available for this cohort of women at significant risk of developing T2DM.This exploratory project sought to describe the changing characteristics of women attending GVH with GDM for 2010, 2015 and 2020, and identify T2DM prevention programs currently offered by Victorian public health services that could be instituted locally to provide postnatal preventative care for women in the Goulburn Valley.
Method: A literature review was conducted to benchmark current rates of T2DM post-GDM in Australia, and identify associated risk factors. A file audit was undertaken to identify demographic characteristics and pregnancy outcomes for three cohorts of women with GDM across 10 years. Descriptive statistics were undertaken to describe the cohorts and identify changes over time. Results were compared to the benchmarked literature. A simple survey regarding currently available T2DM programs post GDM were distributed to 11 Victorian healthcare facilities (8 regional and 3 metropolitan).
Results: n=386 women were included in the audit with a mean age 31.7 years at diagnosis, mean antenatal BMI 31.8kg/m2, n=89 (23%) of whom experienced a GDM recurrence. The cohort was culturally diverse with n=138 (36.1%) born overseas and n=18 (4.7%) Aboriginal or Torres Strait Islander and the majority (n=254; 66%) resided within Greater Shepparton. Over the ten years, service demand increased 74% and the number of insulin initiations increased 90%. The proportion of women with a BMI >30kg/m2 significantly increased between 2015 and 2020. Of the 64% of health services who responded to the survey 3 reported provision of a post-natal T2DM prevention program. Conclusion: A significant gap in current management of post-natal GDM in Victorian public health currently exists. There is a high need for implementation of a postnatal T2DM prevention program in Greater Shepparton. Considering the culturally diverse population serviced in the region, key consumer groups will need to be engaged in program co-design prior to implementation to optimise program reach and potential impact in preventing T2DM.