Quality statement 6: Self‑monitoring of blood glucose levels during pregnancy

Quality statement

Pregnant women with diabetes are supported to self‑monitor their blood glucose levels.

Rationale

Women with diabetes need to be able to self‑monitor their blood glucose during pregnancy. Some women with type 2 diabetes and all women with gestational diabetes will not have been monitoring their blood glucose levels at all before pregnancy and will start doing so. For women with type 1 diabetes, and some women with type 2 diabetes, frequency of monitoring will increase from 4 times a day to up to 10 times per day. More frequent monitoring will help women to maintain good blood glucose control throughout pregnancy. This in turn will reduce the risk of adverse outcomes, such as a baby that is large for gestational age, trauma during birth, neonatal hypoglycaemia and perinatal death. The likelihood of induction of labour and caesarean section should also be lower. Support should be provided to ensure that women have access to appropriate blood glucose meters and are prescribed enough testing strips, and know how to use them.

Quality measures

Structure

a) Evidence of local arrangements and written clinical protocols to ensure that pregnant women with diabetes are supported to self‑monitor their blood glucose levels.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that pregnant women with diabetes have access to appropriate blood glucose meters and are prescribed enough testing strips.

Data source: Local data collection.

Process

a) Proportion of pregnant women with diabetes who feel supported to self‑monitor their blood glucose levels.

Numerator – the number in the denominator who feel supported to self‑monitor their blood glucose levels.

Denominator – the number of pregnant women with diabetes.

Data source: Local data collection.

b) Proportion of pregnant women with diabetes who have an appropriate blood glucose meter.

Numerator – the number in the denominator who have an appropriate blood glucose meter.

Denominator – the number of pregnant women with diabetes.

Data source: Local data collection.

c) Proportion of pregnant women with diabetes who are prescribed enough blood glucose testing strips.

Numerator – the number in the denominator who are prescribed enough blood glucose testing strips.

Denominator – the number of pregnant women with diabetes.

Data source: Local data collection.

Outcome

a) Adverse fetal outcomes.

Data source: Local data collection.

b) Maternal diabetic complications.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (in primary and secondary care) ensure that pregnant women with diabetes have an appropriate blood glucose meter and are prescribed enough testing strips, and so are supported to self‑monitor their blood glucose levels during pregnancy.

Healthcare professionals (GPs, community midwives and healthcare professionals in joint diabetes and antenatal care teams) support pregnant women with diabetes to self‑monitor their blood glucose levels during pregnancy, including ensuring that the woman has an appropriate blood glucose meter and is prescribed enough testing strips.

Commissioners (NHS England area teams and clinical commissioning groups) commission services that ensure that pregnant women with diabetes have an appropriate blood glucose meter and are prescribed enough testing strips, and so are supported to self‑monitor their blood glucose levels.

What the quality statement means for patients

Pregnant women with diabetes are supported to monitor their own blood glucose levels during pregnancy. They are given a blood glucose meter that suits them, and are prescribed enough testing strips for their needs.

Source guidance

Definitions

Appropriate blood glucose meter

Ensure that blood glucose meters meet current ISO standards and take the needs of the woman with diabetes into account.

[Adapted from Type 1 diabetes (NICE guideline NG17) recommendation 1.6.17]

Equality and diversity considerations

When advising women to start or increase the frequency of blood glucose monitoring, take into account that some women may be anxious and feel pressure to adjust and overly regulate their blood glucose levels.