History of gestational diabetes prompting patients to shield under new algorithm

Patients who currently have, or have previously had, gestational diabetes are being targeted via the new QCovid risk algorithm, with many women being asked to shield as a result.

NHS Digital explained to Pulse that this is because these women are at an increased risk of developing type 2 diabetes or having undiagnosed diabetes.

However, GPs warned that this has led to many healthy women contacting practices having been told they should be shielding, while the Royal College of Obstetricians and Gynaecologists said it was ‘investigating’ the issue.

This week, NHS England approved the use of the QCovid risk tool to identify patients who should be shielding because they are at higher risk of complications from Covid-19.

The risk factors taken into account by the tool include gender, age, ethnicity, deprivation, BMI and underlying health conditions such as diabetes and heart disease. Previously, patients had been identified by single risk factors.

As a result, NHS England has been writing to another 1.7 million patients this week, informing them they have been added to the shielding patient list through the tool, with GPs asked to prioritise 820,000 of these for Covid vaccination.

It had emerged throughout Friday that many healthy younger females were being asked to shield

NHS Digital told Pulse that patients with a current or previous history of gestational diabetes, in combination with other factors, are being identified by the QCovid model as being at potentially high risk of complications from Covid.

It said this was confirmed as correct by the University of Oxford, which developed the model, and is in keeping with the precautionary approach to shielding.

It also said patients who felt their history of gestational diabetes was no longer relevant, and felt they did not need to shield, could contact their GP for further advice.

However, GPs said they have been inundated with calls as a result.

Dr Gavin Jamie, a QOF expert and a GP partner in Swindon, told Pulse: ‘We’ve got a fairly young population in our practice, and roughly 20% of these new shielding patients are actually in there for gestational diabetes, and these are women who might have a bit of surprise in getting the shielding letter.

‘In some cases well after delivery, what tends to happen with this is it goes back to normal and we keep an eye on them in the future, but they are not particularly high-risk.’ 

He added that he initially thought their inclusion was ‘a candidate for something that slipped through the net’.

Dr Abbie Brooks, GP partner in York, told Pulse: ‘We’ve already had contact from a couple of patients to say ‘why have I been asked to shield, I have no risk factors whatsoever’’. ‘

She added that her practice – which has around 60,000 patients on its list – has almost 500 extra shielding patients now, of which 100 either have gestational diabetes or no other obvious reason for shielding.

She said she expected most patients from the QCovid list to have conditions such as cardiovascular disease, diabetes, BMI over a certain value, but that she finds the inclusion of gestational diabetes ‘a bit peculiar’, as ‘some fit and well women end up with it, and we weren’t aware that was going to be on the list’.

Meanwhile, the Royal College of Obstetricians and Gynaecologists tweeted: