Original papers Gestational diabetes screening and glycaemic management; National survey on behalf of the Association of British Clinical Diabetologists

Background: There is no UK consensus for screen-ing methodology, diagnosis and management of gestational diabetes mellitus (GDM). Aim: To evaluate routine practice for GDM manage-ment across the UK. Methods: Questionnaires were sent to all members of the Association of British Clinical Diabetologists. They were asked to describe how patients were screened for GDM, the diagnostic criteria and sub-sequent management and clinical targets. Centres that did not respond were followed up by personal communication. Variability trends within regions were assessed. Results: The response rate averaged 46 % nationally (35–67%). Most (85%) units hold a joint clinic, regardless of the size. Most (82%) centres routinely screen for GDM; half universally and half screening high risk pregnancies only. Screening tests, cut-off values, timings and subsequent action vary widely. The first screening test to be used varies, with 40% using glycosuria, followed by random plasma glucose (RPG)(28%), high risk features (11%) then FPG in 6%. Cut-off values for both random and plasma glucose as screening methods also vary. The 75 g oral glucose tolerance test (OGTT) is the most likely confirmatory test to be used if initial screening is positive; however, clinicians rely on different cut-off values and timing. Most (95%) centres routinely assess foetal growth. Postpartum screening is under-taken by 90%, using a 75 g OGTT (93%). Most (90%) centres counsel patients about their high risk for further GDM and type 2 diabetes mellitus. Variability trends in any of the responses could not be detected between different regions in the UK. Conclusion: Standards for GDM screening and man-agement vary significantly across the UK. Although most centres utilize the 75 g OGTT to confirm the diagnosis, there is no consistency in its interpreta-tion. This survey confirms the urgent need for consensus guideline development