What is best practice? A Review of Referrals and Management of Gestational Diabetes in a Rural Diabetes Centre and Comparison with other Rural and Metropolitan Centres. — ASN Events
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What is best practice? A Review of Referrals and Management of Gestational Diabetes in a Rural Diabetes Centre and Comparison with other Rural and Metropolitan Centres. (#350)

Catherine Forbes 1 , Michelle Booth 1 , Stephanie Bakhos 2 , Gina Trakman 2
  1. St Vincents Health & Community Services, Bathurst, NSW, Australia
  2. Student Dietitian, Human Nutrition Unit, , University of Sydney, Sydney, NSW, Australia

Background: Declining numbers of referrals and a desire to ensure best practice prompted a review of the management of GDM at the Bathurst Diabetes Centre.

The aims of the review were to:
1. Assess the attitudes of local GP’s  towards GDM referrals to St Vincent’s and elucidate possible reasons for low referral rates
2. Conduct a literature review to determine best practice recommendations for GDM management
3. Compare the management of GDM between six rural and six metropolitan diabetes education centres

The methodology consisted of 3 parts. Part 1: A written questionnaire delivered to GP’s at the six general practices in Bathurst. Data collected included number of GDM patients seen, services GDM patients are referred to and education provided. Part 2: A literature search to determine the latest recommendations for the management of GDM. Part 3: Phone surveys conducted with Dietitians and Diabetes Educators at six rural and six metropolitan diabetes centres across New South Wales with questions relating to aspects of diabetes management including BG targets, time from referral to intervention, exercise and dietary recommendations and frequency of follow up.

Results of GP surveys indicated 50% of GP’s surveyed refer patients to the Bathurst Diabetes Centre, 31% do not refer and 19% were unaware of the service. Of those not referring 25% refer patients to a diabetes specialist whilst the other 75% provide information on diet, exercise and blood glucose monitoring themselves (38%) and/or refer to the practice nurse or Dietitian for education. Results of Diabetes Educator and Dietitian surveys indicated 83% of Dietitians surveyed teach some form of carbohydrate counting and 75% teach Glycaemic Index. 18% of Diabetes educators advocated for testing 1 hr post prandially and 82% for 2 hrs. 

Overall, the results showed no major differences between rural and metropolitan centres in terms of information provided to clients, but there were differences in degree of access to diabetes specialists in smaller rural centres and higher utilisation of group education in larger metropolitan centres.