Meloncelli Nina, Barnett Adrian, Pelly Fiona, de Jersey Susan
School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
Nutrition and Dietetics, Allied Health, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2019 Apr;59(2):208-214. doi: 10.1111/ajo.12816. Epub 2018 Apr 18.
Gestational diabetes mellitus (GDM) is one of the most common pregnancy disorders; however, if well managed, women with GDM experience similar pregnancy outcomes to those without. Currently, there is limited evidence on actual management practices across Australia or how multidisciplinary teams interact to optimise care.
To examine the current screening, diagnostic, task and role perceptions and management practices, as reported by members of the GDM multidisciplinary team.
A 64-item electronic survey containing multiple choice, Likert scale and open-ended questions was developed for this cross-sectional observational study and advertised through health professional organisations and Queensland Health facilities in May and June, 2017.
The 183 survey respondents included 45 diabetes educators, 43 dietitians, 21 endocrinologists/diabetes specialists, 14 obstetricians and 21 midwives. Although almost 90% reported using updated diagnostic guidelines, less than two-thirds used GDM management guidelines. While 68% reported using the same blood glucose targets for GDM management, there was variation to what criteria prompted the commencement of medication to control blood glucose levels. There was a good consensus concerning the health professional responsible for tasks such as medical nutrition therapy, gestational weight gain and self-blood glucose monitoring education and ultrasound use. Other tasks appeared to be the role of almost any member of the GDM multidisciplinary team.
The survey results indicate there is a need for consistent evidence on how to best manage GDM and that role identity, access to specialist knowledge and best practice need to be clearly defined within GDM models of care.
妊娠期糖尿病（GDM）是最常见的妊娠疾病之一；然而，如果管理得当，患有GDM的女性与未患GDM的女性妊娠结局相似。目前，关于澳大利亚各地实际管理做法或多学科团队如何相互协作以优化护理的证据有限。
调查GDM多学科团队成员报告的当前筛查、诊断、任务和角色认知以及管理做法。
针对这项横断面观察性研究，设计了一份包含多项选择题、李克特量表和开放式问题的64项电子调查问卷，并于2017年5月和6月通过卫生专业组织和昆士兰卫生设施进行宣传。
183名调查受访者包括45名糖尿病教育者、43名营养师、21名内分泌科医生/糖尿病专家、14名产科医生和21名助产士。尽管近90%的受访者报告使用了更新的诊断指南，但不到三分之二的人使用GDM管理指南。虽然68%的受访者报告在GDM管理中使用相同的血糖目标，但在启动药物治疗以控制血糖水平的标准方面存在差异。对于负责医学营养治疗、孕期体重增加、自我血糖监测教育和超声检查等任务的卫生专业人员，存在良好的共识。其他任务似乎几乎是GDM多学科团队任何成员的职责。
调查结果表明，需要有关于如何最佳管理GDM的一致证据，并且在GDM护理模式中需要明确界定角色身份、获取专业知识的途径和最佳实践。
