یافته های اخیر مجله ی National Pregnancy در گزارش حسابرسی دیابت Latest findings from the National Pregnancy in Diabetes audit report

The National Diabetes Audit has, over the years, produced some challenging reports about the quality of NHS diabetes care. One of its strengths is the honesty with which it describes the data, whether it is a failure to achieve targets in care delivery or a high frequency of medication errors among inpatients. So when the latest report from the National Pregnancy in Diabetes (NPID) audit1 begins with the quote ‘It’s time for diabetes and maternity networks to work together and get a grip on finding solutions to improve obstetric and neonatal outcomes of women with diabetes’ from Helen Murphy, Professor of Medicine (Diabetes and Antenatal Care), University of East Anglia, and Professor Women’s Health, King’s College London, it is evident we can expect some sobering statistics. It is not the only quote; another two are less direct but still pointed, noting: ‘There is a lot more that could be done to encourage women to get pregnancy ready and to help with a happy and healthy pregnancy’ (patient representative), and ‘The NPID audit continues to demonstrate excellent collaboration between professional and patient groups to provide important but concerning information about mothers and babies…’ (Dr Jane Hawdon, Consultant Neonatologist, Royal Free London NHS Foundation Trust). How the audit is conducted The NPID audit evaluates the quality of antenatal care and pregnancy outcomes for women with pregestational diabetes. It is part of the National Clinical Audit and Patient Outcomes Programme, which is commissioned by the Healthcare Quality Improvement Partnership (led by the Academy of Medical Royal Colleges, the Royal College of Nursing, and National Voices) and funded by NHS England. The audit addressed three questions: • Were women with diabetes adequately prepared for pregnancy? • Were appropriate steps taken during pregnancy to minimise adverse outcomes to the mother? • Were adverse fetal and neonatal outcomes minimised? The quality of care was assessed against the recommendations made by NICE in its 2015 guideline ‘Diabetes in pregnancy: management from preconception to the postnatal period’.2 (Box 1.) Overview The latest audit included data from 2016 provided by 172 services in England, Wales and the Isle of Man (with foci in London, the North West and the North East) for 3297 women and 3304 pregnancies. Since 2014, the reference year for some comparisons in the report, an additional 22 services contributed data. About half of women had type 1 diabetes (T1D) and about half had type 2 diabetes (T2D), with a small number having ‘other’ diabetes. There was large variation between the regions in the proportion of women with T1D or T2D, ranging from 27% in London to 60% in Wales for T2D and, for T1D, 39% in the South West and 71% in London. Since 2014, the overall proportion of women with T2D in the audit rose from 44% to 50%. They tended to be slightly older (median 34 vs 30 years), had a higher median BMI (32.6 vs 26.1kg/ m2) and a shorter median duration of diabetes (4.0 vs 14 years) than women with T1D. White women made up 78% of women with T1D but only 40% of those with T2D. Two-thirds of women with T2D were in the lowest two quintiles for social deprivation.