Some people with previous gestational diabetes were identified by the QCovid® model as being at high risk. This will be appropriate for many as the model performs an individual assessment based on a wide range of risk factors, and also considers a person's risk in comparison to others of the same age and sex.
However, because the risk assessment is based on routinely coded data from multiple systems, some people may have been identified as having diabetes when in fact they had gestational diabetes. Others may have incomplete data, in which case the risk assessment may have defaulted, on a precautionary basis, to a higher level of risk for that category and this may influence the overall assessment results.
If a person was identified as being at high risk due to previous gestational diabetes only (no other significant conditions) and both:
- had a Body Mass Index (BMI) between 16 and 41
- had a HbA1c (a test to check average blood glucose/sugar levels) since delivery and within the previous 12 months which is normal or in the pre-diabetes or non-diabetic hyperglycaemia range
they did not need to be included in the SPL and could have been removed if they requested this. They would have still been called for an earlier vaccine. Shielding was advisory and people who received a letter could choose whether or not to follow shielding advice. Clinicians were able to use their clinical judgement and discuss any decision to remove a patient from the SPL.
Where a person with previous gestational diabetes, and a normal HbA1c in the previous 12 months, has a BMI below 16 or above 41, the COVID-19 Clinical Risk Assessment Tool was available to generate the patient’s risk assessment results. These results were used to inform an individual assessment of risk to determine, in consultation with the patient, whether they should remain on the SPL or be removed.
Importantly, people with previous gestational diabetes have an increased risk of developing Type 2 diabetes (which would put them at higher risk from coronavirus) and they should continue to undergo the recommended annual checks for this.
The Royal College of General Practitioners (RCGP) developed a flow chart to support GPs when considering risk for patients with a history of gestational diabetes.