The glucose management of gestational diabetes in the UK: a national survey
Abstract Background There has never been a detailed assessment of the management of gestational diabetes (GDM) previously in the UK. Methods We conducted a national electronic survey (September 2022– June 2023) and mixed quantitative and qualitative analyses to evaluate glucose targets and glucose m...
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BMC
2025-08-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-025-07881-w |
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| author | Isabelle K. Mayne Maximilian J. Levy Bijay Vaidya Andrew P. McGovern |
| author_facet | Isabelle K. Mayne Maximilian J. Levy Bijay Vaidya Andrew P. McGovern |
| author_sort | Isabelle K. Mayne |
| collection | DOAJ |
| description | Abstract Background There has never been a detailed assessment of the management of gestational diabetes (GDM) previously in the UK. Methods We conducted a national electronic survey (September 2022– June 2023) and mixed quantitative and qualitative analyses to evaluate glucose targets and glucose management in GDM across the UK. The response rate was 52% (73/141 National Health Service [NHS] trusts) with data covering 83 hospitals. Results Most hospitals use the National Institute for Health and Clinical Excellence (NICE) recommended glucose targets; the most common fasting target was 5.3 mmol/L (n = 70 hospitals; 84%); and the post-prandial 7.8 mmol/L 1-h target (n = 72; 92%) and 6.4 mmol/L 2-h target (n = 40; 78%). Metformin is used as the preferred first-line option for post-prandial and fasting blood glucose reduction in 84% of hospitals (with Modified-release metformin used initially in 17%). Insulin is used as the preferred first line in 28% for fasting and 19% for post-prandial glucose. In components of management not covered by national guidelines, there is wide practice variation, including insulin preparations used, starting doses, and titration rates. Standard insulin initiation doses ranged from 1–12 units for meal-time insulin and 2–20 units for basal insulin. There was a 13-fold difference in insulin titration rates from 0.3 units/day up to 4 units/day. The maximum basal insulin dose achievable during the first six weeks of titration varied from 15 to 182 units. Conclusions In GDM glucose management components not covered by national guidelines there is wide practice variation; slow insulin titration in some hospital protocols is of particular concern. |
| format | Article |
| id | doaj-art-c049ecbe8c904c3d9ebcbea8d0595fb8 |
| institution | Kabale University |
| issn | 1471-2393 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | BMC Pregnancy and Childbirth |
| spelling | doaj-art-c049ecbe8c904c3d9ebcbea8d0595fb82025-08-20T03:46:12ZengBMCBMC Pregnancy and Childbirth1471-23932025-08-0125111010.1186/s12884-025-07881-wThe glucose management of gestational diabetes in the UK: a national surveyIsabelle K. Mayne0Maximilian J. Levy1Bijay Vaidya2Andrew P. McGovern3University of Exeter Medical SchoolKeele University School of MedicineUniversity of Exeter Medical SchoolUniversity of Exeter Medical SchoolAbstract Background There has never been a detailed assessment of the management of gestational diabetes (GDM) previously in the UK. Methods We conducted a national electronic survey (September 2022– June 2023) and mixed quantitative and qualitative analyses to evaluate glucose targets and glucose management in GDM across the UK. The response rate was 52% (73/141 National Health Service [NHS] trusts) with data covering 83 hospitals. Results Most hospitals use the National Institute for Health and Clinical Excellence (NICE) recommended glucose targets; the most common fasting target was 5.3 mmol/L (n = 70 hospitals; 84%); and the post-prandial 7.8 mmol/L 1-h target (n = 72; 92%) and 6.4 mmol/L 2-h target (n = 40; 78%). Metformin is used as the preferred first-line option for post-prandial and fasting blood glucose reduction in 84% of hospitals (with Modified-release metformin used initially in 17%). Insulin is used as the preferred first line in 28% for fasting and 19% for post-prandial glucose. In components of management not covered by national guidelines, there is wide practice variation, including insulin preparations used, starting doses, and titration rates. Standard insulin initiation doses ranged from 1–12 units for meal-time insulin and 2–20 units for basal insulin. There was a 13-fold difference in insulin titration rates from 0.3 units/day up to 4 units/day. The maximum basal insulin dose achievable during the first six weeks of titration varied from 15 to 182 units. Conclusions In GDM glucose management components not covered by national guidelines there is wide practice variation; slow insulin titration in some hospital protocols is of particular concern.https://doi.org/10.1186/s12884-025-07881-wDiabetesGestationalManagementInsulin |
| spellingShingle | Isabelle K. Mayne Maximilian J. Levy Bijay Vaidya Andrew P. McGovern The glucose management of gestational diabetes in the UK: a national survey BMC Pregnancy and Childbirth Diabetes Gestational Management Insulin |
| title | The glucose management of gestational diabetes in the UK: a national survey |
| title_full | The glucose management of gestational diabetes in the UK: a national survey |
| title_fullStr | The glucose management of gestational diabetes in the UK: a national survey |
| title_full_unstemmed | The glucose management of gestational diabetes in the UK: a national survey |
| title_short | The glucose management of gestational diabetes in the UK: a national survey |
| title_sort | glucose management of gestational diabetes in the uk a national survey |
| topic | Diabetes Gestational Management Insulin |
| url | https://doi.org/10.1186/s12884-025-07881-w |
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