Some people with previous gestational diabetes have been 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 has been identified as being at high risk due to previous gestational diabetes only (no other significant conditions) and both:
- has a Body Mass Index (BMI) between 16 and 41
- has had a HbA1c (a test to check average blood glucose/sugar levels) since delivery and within the last 12 months which is normal or in the pre-diabetes or non-diabetic hyperglycaemia range
they do not need to be included in the Shielded Patient List (SPL) and can be removed if they request this. They will still be called for an earlier vaccine. Shielding is advisory and people who have received a letter can choose whether or not to shield. Clinicians should always 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 can be used to generate the patient’s risk assessment results. These results should be used to inform an individual assessment of risk to determine, in consultation with the patient, whether they should remain on the Shielded Patient List (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) has developed a flow chart to support GPs when considering risk for patients with a history of gestational diabetes.