Poster Presentation International Association of the Diabetes and Pregnancy Study Groups 2022 - Hosted by ADIPS

Implementation of fluoride-citrate tubes to stabilise glucose for detecting GDM in Kimberley Aboriginal Community Controlled Health Services: a mixed methods assessment. (#138)

Erica P Spry 1 2 , Emma L Jamieson 3 , Lorraine Anderson 1 , Mark Hoey 3 , Andrew Kirke 3 , David Atkinson 2 , Julia V Marley 2
  1. Kimberley Aboriginal Medical Services, Broome, WA, Australia
  2. The Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, Australia
  3. The Rural Clinical School of Western Australia, The University of Western Australia, Bunbury, WA, Australia

Background:

OGTT completion by women in rural and remote Western Australia is low (50.5%) and an estimated 62% of GDM is missed due to glucose instability in fluoride-oxalate (FLOX) samples and long delay to laboratory analysis. In September 2019 Kimberley Aboriginal Community Control Health Services (ACCHS) implemented fluoride-citrate (FC) tubes to immediately stabilise OGTT samples.

Aims:

To describe implementation of FC tubes and evaluate the impact on detection of GDM.

Method:

A mixed methods approach was used: a retrospective audit and qualitative interviews with clinicians. Electronic medical records for 951 women attending a Kimberley ACCHS with an estimated date of delivery between 2018-2021 were audited for maternal characteristics and risk-factors, OGTT (ADIPS criteria) and birth outcomes (large- and small-for-gestational-age (LGA >90th centile; SGA <10th centile) calculated using Perinatal Institute GROW v8.0.1). Clinicians delivering antenatal care in rural and remote primary and secondary health care (hospitals clinics, ACCHS, general practice, remote clinics) were interviewed. Interviews were professionally transcribed into individual Microsoft Word documents, imported into NVivo 12, then coded and analysed using a directed qualitative content analysis approach.

Results:

Of 698 (672 Aboriginal) women eligible for an OGTT ≥24-weeks, 51.7% completed testing (152 FC tubes; 209 FLOX tubes). Clinicians reported a discordance between clinical presentation during pregnancy and OGTT result when using FLOX tubes. This was often confirmed when women delivered a LGA newborn. No significant differences in GDM risk-factors were observed between FLOX- and FC-groups, however as expected GDM incidence was 2.8-fold higher in the FC-group (37.5% v 15.8% FLOX, P <0.001). Three-quarters of women with GDM in the FC-group were diagnosed with fasting glucose. When FC tubes were first introduced clinicians were concerned that women were being over diagnosed, however with time they realised that they were detecting women with GDM. This was reflected in the 3.7-fold increase in pharmaceutical intervention (metformin and/or insulin; 12.1% v 3.2% FLOX, P <0.001). Induction of labour and birth weight outcomes were similar between groups (FC v FLOX, induction: 43.6% v 37.3%, P = 0.217; LGA: 13.5% v 9.0%, P = 0.369; SGA: 18.4% v 14.6%, P = 0.602).

Conclusions:

As expected, implementation of FC tubes significantly increased GDM diagnosis. A concurrent increase in pharmaceutical intervention was observed, likely reflecting increased clinician awareness and concern about GDM during the timeframe. Larger cohorts are required to evaluate whether improved detection and management of GDM translates to improved birth outcomes.