Dr David McIntyre Outlines How the COVID-19 Pandemic Impacted GD Management, Diagnoses

Countries came up with alternatives to the glucose tolerance test for pregnant women throughout the pandemic to limit risk of COVID-19 exposure, explained David McIntyre, MD, FRACP, a professor of medicine and an endocrinologist at the University of Queensland in Brisbane, Australia. McIntyre's talk on the changes in diagnoses and management of gestational diabetes (GD) was presented at the ADA's 81st Scientific Sessions.

Transcript

Can you introduce yourself and describe your work?

My name is David McIntyre, and I'm a professor of medicine and endocrinologist at the University of Queensland in Brisbane, Australia. As well as endocrinology, I work in obstetric medicine or medical complications of pregnancy more broadly than just endocrinology. I have been interested for a very long time in diabetes and obesity, particularly during pregnancy.

Can you give an overview of your talk "Diagnosis and Management of Diabetes in Pregnancy During the COVID-19 Pandemic?"

The talk I presented at the ADA meeting was really dealing with changes that have been either proposed or implemented for diabetes and pregnancy management, diagnosis, in fact, and management during the COVID-19 pandemic. Now, I guess the first changes were made very early on, where a number of countries around the world became very concerned that the glucose tolerance test, which is routinely used to diagnose gestational diabetes, was a potential exposure risk for COVID-19, in that women would be spending a lot longer in pathology collection centers for a 2- or 3-hour test. Also they might have been in the same centers being in contact with people having COVID-19 tests. Of course, there have been many things that have happened since that that have proven that people can get COVID-19 just about anywhere and also that the testing centers tend to segregate people with respiratory symptoms from others. The context has evolved and changed a bit since we first started thinking about this.

Essentially, what happened at that early stage, and we're talking around about March-April 2020, was that a number of bodies in various countries, in fact—not including the United States, but including Canada, the United Kingdom, and Australia—came up with varying approaches to how, without doing a glucose tolerance test, one might approach the diagnosis of gestational diabetes. Essentially, that's the topic of my talk, what changed, particularly in diagnosis, and then also moving on to what changed by way of treatment.

Now, in that same seminar, there was an excellent presentation, dealing with telehealth itself. So telehealth is obviously one of the major responses, and I certainly acknowledge that, but I didn't deal with that extensively. But the other things that have changed are the use of various technologies, such as flash monitoring and continuous glucose monitoring testing. All of these have led to really quite a change in context for women with diabetes and pregnancy during the COVID-19 pandemic. There's some data now suggesting what has happened in terms of overall pregnancy outcomes with not just COVID-19 itself, but the strain of being locked up, the strain of being worried about various things, including loss of employment and illness and a whole range of things that have obviously affected pregnant women, perhaps disproportionately, particularly being locked inside with all your children, for instance. There's been a lot of interest in what has happened to overall pregnancy outcomes, and there's now some publications dealing with that specifically, in women affected by diabetes and pregnancy.