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GPs can remove some patients with previous gestational diabetes from shielding list


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Patients identified as high-risk by QCovid for previous gestational diabetes alone may be manually removed from the shielding list in certain cases, NHS Digital has said.

In a previous update, NHS Digital said some young, healthy women were being told to shield due to previous gestational diabetes, and that the QCovid risk tool is being ‘actively reviewed’.

However, the body has now added that GPs can remove a person included for previous gestational diabetes if the patient meets a certain risk criteria and requests this.

To be removed, the patient must have ‘no other significant conditions’ along with a BMI of ‘between 16 and 41’, and a HbA1c test taken ‘since delivery and within the last 12 months which is normal or in the pre-diabetes or non-diabetic hyperglycaemia range’.

Though the patient would be removed from the shielding list, they would still be called for an early Covid vaccine, NHS Digital said.

It added that GPs should always use their ‘clinical judgement’ and discuss any decision to remove a patient from the list, and pointed to an RCGP resource to support this.

NHS Digital said: ‘Importantly, women 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 statement again clarified that many people with previous gestational diabetes have been appropriately identified by QCovid as being at high-risk, adding that the QCovid model assesses ‘a wide range of risk factors’. 

It said that some people may have been identified as having diabetes when in fact they had gestational diabetes, as the assessment is based on routinely coded data from multiple systems. Others could have ‘incomplete data’, meaning the system may have defaulted to a higher risk level ‘on a precautionary basis’, it added.

Pulse reported last week that GPs were being inundated by women who were being told to shield, despite not being at high risk from Covid-19.

READERS' COMMENTS [2]

Richard Kinsman 27 February, 2021 8:40 am

Does being diabetic automatically make you Highest [Shielding]?
Does being pregnant automatically make you Highest [Shielding]?
Does the combination do so?
Even if it does none of our flagged patients are currently pregnant and none have diabetes- they would be code if they were… The inclusion of these patients seems to be on the assumption GPs not followed up their patients or coded them accurately etc.
Why does being at risk of developing diabetes through gestational diabetes in past make you Highest [Shielding] whilst pe-diabetes does not?
There also seems to be confusion about highest risk partly due to the available Snomed coding. Reminder: Highest-High=Shielding High=Moderate=Social Distancing and the rest are Low Folks are confusing Highest and High.

Gavin Jamie 1 March, 2021 3:58 pm

There is no input to the formula for pre-diabetes. For some reason patients with gestational diabetes have been coded as having current type two diabetes. This interacts with the shielding criteria which are, in part, based on the relative risk to people of your age.
Thus they appear as type two diabetes in young people who will have a low background risk. Their relative risk appears high so they are put on the shielding risk. Their absolute risk remains small in most cases.

The criteria for removal look well defined and could be applied by an automatic process, although there seems to be little appetite to develop one.