Article Preview
TopIntroduction
Diabetes mellitus is one of the leading chronic diseases affecting Australians and its prevalence continues to rise. The total number of diabetes patients worldwide is estimated to rise to 366 million in 2030 from 171 million in 2000 (Wild et al., 2004). With increasingly growing prevalence which includes an estimated 275 Australians developing diabetes daily (DiabetesAustralia, 2008), Australia is expected to be a significant contributor to this projected trend. An estimated 700,000 Australians, representing approximately 3.6% of the population, were diagnosed with diabetes in 2004-05. Between 1989-90 and 2004-05 the proportion of Australians diagnosed with this disease more than doubled from 1.3% to 3.3%. Additionally, between 2000-01 and 2004-05, Australian diabetes hospitalizations increased by 35% from 1,932 to 2,608 hospitalizations per 100,000 people (AIHW, 2007, 2008). For every person diagnosed with diabetes, it is estimated that there is another who has yet to be diagnosed, which doubles the number of diabetes sufferers (DiabetesAustralia, 2008). Diabetes is, thus, one of the fastest growing chronic diseases in Australia (AIHW, 2008; Catanzariti, Faulks, & Waters, 2007; Chittleborough et al., 2007). Diabetes and its complications incur significant costs for the health system in Australia, including costs incurred by care providers, government, and the entire health system (DiabCostAustralia, 2002). In 2004-05 direct healthcare expenditure on diabetes was A$907 million, which constituted approximately 2% of the recurrent health expenditure that is to be allocated in that year (AIHW, 2007, 2008). Further costs include societal costs that represent productivity losses for both patients and their care providers (DiabCostAustralia, 2002).
Gestational diabetes mellitus (GDM) is a common form of diabetes that presents in pregnancy, sometimes with symptoms but often diagnosed in otherwise normal women on routine screening tests. Some women, particularly those in whom the diagnosis of GDM is made early in pregnancy, may have pre-existing undiagnosed diabetes. In Australia and New Zealand, universal screening for GDM is recommended by the Australasian Diabetes in Pregnancy Society (ADIPS) (Hoffman et al., 1998), although the uptake of this recommendation is rather variable (Rumbold & Crowther, 2001). It is estimated that in Australia, 3-6% of pregnant women will develop GDM at around 24-28 weeks gestation, with a smaller number earlier and later in pregnancy. An Australian study of 210 pregnant women found that screening for GDM had an adverse impact on women's perceptions of their own health (Rumbold & Crowther, 2001, 2002). GDM is more common in older women, in those with a family history of diabetes, in those who are overweight, and in those of non-Caucasian heritage (Carolan, Steele, & Margetts, 2010). Maternal complications of GDM can be serious and include polyhydramnios and premature labor, maternal hypertension, low birth weights and stillbirth (Fan et al., 2006; Hoffman et al., 1998). It recurs in subsequent pregnancy in 30-80% of women, the incidence varying with ethnicity, being lower in Caucasian women (Kim, Berger, & Chamany, 2007).