Routine Hba1c s Are Not Cost Effective And The Model...

There is an unresolved debate on whether routine HbA1c’s are not cost effective and the model should remain as women receiving a polycose test at 24-28 weeks. An HbA1c is a blood test that requires no consumption of concentrated glucose drinks or fasting. It measures the amount of blood glucose over the prior 120 days (Sevket, Sevket, Ozel, Dansuk Kelekci, 2014). It has however been concluded that HbA1c’s are not an alternative for diagnosis of GDM and are not useful in reduces the need for further diagnostic testing (Sevket, Sevket, Ozel, Dansuk Kelekci, 2014). Therefore not all guidelines are updated to follow these recommendations supported by the MOH (2014) REFERENCE and REFERENCE. The algothrithm for ADHB (2013) and WDHB (2012) follow the ‘risk screening’ approach where only women with risk factors are offered an HbA1c, all other women are offered the routine polycose at 24-28 weeks. Victorias midwife followed these guidelines. The screening and dia gnosis of GDM also detects unrecognised type two diabetes and rarely type one (Pairman et al., 2015) because the pathophysiology of type 2 diabetes mellitus includes insulin resistance, similar to GDM. Thus pregnancy provides a window of opportunity to identify women at risk of developing type 2 diabetes or who may be in the prediabetic state (Lacroix et al, 2013; Chasam-Taber, 2015). Prehaps if Victoria was offered an HbA1c at booking her GDM might have been recognised earlier. Prior to her polycose her pregnancy had