Aboriginal and Torres Strait Islander women are disproportionately impacted by type 2 diabetes (T2DM) at a young age and have high rates of pre-existing diabetes in pregnancy. Maternal hyperglycaemia is one of the most important modifiable risk factors which can improve pregnancy and birth outcomes. T2DM in younger people is associated with challenging social determinants of health, remoteness, smoking and obesity. Enhancing culturally appropriate referral pathways, communication, workforce capacity and skills, health literacy of both health professionals and women are measures which are crucial to diabetes in pregnancy care. As part of a current health systems improvement project in Far North Queensland (Diabetes across the Lifecourse: Northern Australia Partnership) these issues are being addressed, and an interim evaluation has identified early successes.
Diabetes technology such as continuous glucose monitoring is a promising adjunct to other measures, however, has not been widely accessible or studied among Aboriginal and Torres Strait Islander women, or with T2DM in pregnancy. Continuous glucose monitoring has been shown to improve neonatal outcomes for women with type 1 diabetes in pregnancy. Flash glucose monitoring is a type of intermittently scanned continuous glucose monitoring (iscCGM) system. We conducted a pilot study to assess the feasibility and acceptability of using iscCGM for women with pre-existing T2DM in pregnancy. Three quarters of participants were Aboriginal or Torres Strait Islander and 30% lived remotely (>100km from the city). We found that iscCGM was acceptable for the majority of women and preferable to finger-stick monitoring. Feasibility assessment revealed a wide variability of sensor use and indicated that earlier referrals, culturally appropriate systems of care and access to diabetes educators and are vital to optimise iscCGM use. These results will inform future randomised trials which are needed to demonstrate improvements in pregnancy outcomes.