The Hyperglycemia and Adverse Pregnancy Outcome Study (HAPO) published in 2008 has resulted in the formulation of new consensus guidelines for the testing and diagnosis of GDM. Endorsed by a number of national organisations, and with its impending adoption in Australia, it has implications for service delivery.

The Illawarra has a population of ≈290, 000. Ethnicity is representative of the national data. The number of births each year in the region is ≈3300 .With existing ADIPS criteria the prevalence of GDM is 9.6%. With the new criteria the prevalence is 13%. The experience of the service suggests this may be an underestimation.

Local agreement was sought from relevant obstetric care providers to use the new criteria from January 2011. New action point criteria were also introduced at this stage. Dealing with the increase in numbers and an increased need for treatment other than diet were identified as the primary challenges. Women with GDM attending the Diabetes Service have increased from 230(7% of total births) in 2010 to 452(13.6%) in 2011. Current prediction for 2012 is ≈ 600(≈18.2%). The numbers requiring insulin treatment has increased from ≈16% to ≈40 %.

Service delivery has been rapidly changed from a medical model to a nurse/ dietitian clinics with closer integration with antenatal services. Increasing the use of group education sessions and group insulin commencements reduces 1: 1 clinical contact. A protocol approach for the treatment can be facilitated for the use of insulin and more recently metformin

This above model identifies an area that could promote a greater role for nurse practitioners. Without which there will always remain a requirement for a major medical presence. It is also acknowledged that areas with a high proportion of women from a NESB will place extra demands on service delivery.