Ms Jennifer Barrett1, Ms Bernadette Heenan1
1Apunipima Cape York Health Council, Manoora, Australia
Pregnant women with pre-existing type 2 Diabetes Mellitus (T2DM) are at a higher risk of adverse maternal and perinatal outcomes and commonly require significant increases in insulin over the course of the pregnancy. Managing these high-risk pregnancies requires collaboration between a range of health professionals including community midwives, Credentialed Diabetes Educators (CDEs), Obstetricians and Endocrinologists. Continuous Glucose Monitoring (CGM) can play a role in improving glycaemic control for these clients.
A client whose fifth pregnancy was complicated by pre-existing T2DM, proteinuria, essential hypertension and retinopathy was provided with a CGM device from 22 weeks gestation until one month postpartum. The client was identified as a candidate for CGM monitoring by the CDE due to her high-risk pregnancy, food insecurity, frequent hypoglycaemic episodes and her challenges of balancing work and family life with diabetes management. Weekly CGM data was downloaded by the client at her local clinic and transmitted to the CDE who collaborated closely with the regional endocrinologist allowing for regular and timely insulin adjustments. The client demonstrated a marked improvement in glycaemic control as evidenced by her daily insulin requirements decreasing from 30 unit of mixed insulin to 3 units of short acting with carbohydrate meals. She and her family became highly motivated and engaged in her diabetes management and she gave birth, at term, to a healthy baby.
CGM offers an exciting opportunity to improve diabetes self-management for women with DIP who live in remote areas. Detailed graphic reports increased client awareness of glycaemic excursions and improved inter-professional collaborative care with improved outcomes for mother and infant.
Bernadette Heenan, Credentialed Diabetes Educator, Apunipima Cape York Health Council. BA, Grad Dip Lib Sc, RN, CDE
Jennifer Barrett, Midwife & Child Health Nurse, Apunipima Cape York Health Council. RN, RM, M. Midwifery, M. Public Health & Tropical Medicine