Understanding barriers to accurate early laboratory diagnosis and patient centric control of Gestational Diabetes Mellitus

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Gestational diabetes mellitus (GDM) is a condition characterised by high blood glucose levels, with first onset during pregnancy. GDM increases the risk of complications for both mother and child. Evidently, early detection and treatment improve outcomes, but many women are at serious risk of going undiagnosed due to a lack of universally accepted diagnostic criteria, and disagreement over the glucose range deemed healthy. The most commonly used range is reported by the World Health Organisation to be 'somehow arbitrary'. Furthermore, poorly controlled GDM leads to adverse maternal and infant outcomes and increased likelihood of developing type 2 diabetes later in life. On the other hand, tight glucose control increases the risk of severe hypoglycaemia (low glucose levels), which may also compromise the wellbeing of mother and child. The overall clinical goal is to improve the criteria, enable diagnosis as early as possible in pregnancy, discover better GDM markers and improve management of the condition to ensure that blood glucose levels remain under control throughout pregnancy. In addition to the impact on wellbeing and quality of life for both mother and child, any improvement in the management of this condition will reduce the burden on the national economy. By facilitating hospital-based training for an engineering scientist, this discipline hop has the following aims:- gaining for the principal investigator of a full grasp of the clinical challenges preventing the transformation of diagnosis and treatment of GDM;- the establishment of a permanent network linking engineering science specialists with endocrinologists, obstetricians, pathologists, other allied healthcare colleagues and patients to tackle together the unsolved challenges of effective GDM care;- the co-creation by the principal investigator and the other stakeholders above of a research strategy to improve GDM care.The project will look at utilisation of routinely collected NHS data for research, give consideration to glucose variability to go beyond diagnosis based on glucose levels at single time points, and to personalisation for better management of glucose variability throughout pregnancy. The training will include:(a) engagement with patients and clinical professionals to understand how GDM is currently managed in the clinic, the practical realities constraining current practice, and how patients and different clinical professionals envisage improving care beyond today's approaches founded on population averages towards personalised alternatives(b) training in available databases and laboratory sample testing to learn the structure of routinely collected NHS data, identify their limitations, and the implications for data analyses and modelling(c) training in Good Clinical Practice covering ethical and regulatory requirements for research, the code of conduct for clinic-based research, a researcher's responsibilities towards study participants, limitations of measurements, reliability of data and other areas that are typically left unexplored by engineering and physical sciences researchers, and(d) experience in recruitment for longitudinal measurements, together with assessment of our ability to recruit and the feasibility of personalisation based on longitudinal data obtained from continuous glucose monitoring, via preliminary data analysis and modelling.As a long-term goal, the emergent collaboration aims to support the EPSRC Healthy Nation programme via better understanding of individual glucose variability, optimised care through effective diagnosis, patient-specific prediction and evidence-based treatment planning, minimisation of costs of care and reduction of risks to GDM patients and their children. The knowledge acquired from the project will form a platform to translate our findings into a large scale trial, which in turn can form the basis of changing current clinical practice in this field.