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The Challenge to Deliver Cost Effective Care for Patients with Gestational Diabetes Mellitus

Julie A Quinlivan

The global rise in obesity and gestational weight gain, along with recent trials demonstrating improved pregnancy and neonatal outcomes associated with the treatment of mild hyperglycaemia, have resulted in a clinical challenge to deliver cost effective healthcare to manage the epidemic of Gestational Diabetes Mellitus (GDM). Whilst clinicians now have clear criteria by which to diagnose GDM, and the glycaemic targets to achieve, less clear are the pathways to achieve these outcomes in a cost effective manner. The value of using allied health providers such as dieticians compared to less trained patient educators, the effectiveness of individualised versus group dietician counselling, the role of antenatal investigations such as CTG and ultrasound, the degree of monitoring of maternal blood sugar level, the type of medications to complement dietary therapy, along with policies on delivery and postnatal care, all need to be refined through studies or audits. Having identified the problem and established diagnostic and treatment targets, the next challenge is to provide evidence-based, cost-effective care.