Impact of the introduction of National Institute for Health and Care Excellence (NICE) guideline NG3
Published Date: 19th July 2016
Publication Authors: Bujawansa S, McNulty S, Wilkinson P, Michaels S, Pankaja S
Aims
NICE updated its guidance on diabetes in pregnancy in February 2015. The changes included recommending cut-off values for diagnosing gestational diabetes (GDM) and lowering the target pre-prandial glucose levels from <5.9 to <5.3 mmol/l. We were using World Health Organisation (WHO) glucose values (fasting <7 and 1 h < 7.8 mmol/l) to diagnose GDM. We aimed to assess the impact of the introduction of NG3 on our service delivery and patient care.
Methods
Retrospective review of patient records of women who attended 19 consecutive weekly joint antenatal clinics before and after the introduction of NG3.
Results
The average number of new referrals per clinic increased from 3.9 to 5.15 and the number of follow-ups increased from 7 to 11.8. The percentage with GDM on any form of treatment increased from 33% to 49% and the percentage on insulin increased from 20% to 36%. Patients requiring the addition of insulin to metformin increased from 12.5% to 54%. There was no significant difference in birth weight (3.54 vs 3.48 kg, p = 0.5), gestation at delivery (38 vs 38.2 weeks, p = 0.5), birth weight >4 kg (11% vs 13%), percentage admitted to special care baby unit (2.6%, 4.6%, p = 1) before and after the introduction of NG3. The rate of emergency caesarean sections increased to 18% from 6% but was not statistically significant.
Conclusions
The introduction of NG3 has resulted in a large increase in the number of women diagnosed with GDM and number with GDM requiring treatment. It has not improved maternal and fetal outcomes further.
Bujawansa, S; Rothwell, E; McNulty, S; Wilkinson, P; Michaels, S; Qureshi, L; Pankaja, S. (2016). Impact of the introduction of National Institute for Health and Care Excellence (NICE) guideline NG3 on diabetes in pregnancy on service delivery and patient care in a district general hospital in the northwest of England . Diabetic Medicine. 33 (S1), 170
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