Preconception clinic in type 1 diabetes — counselling and planning station

Simulated-patient preconception counselling station in type 1 diabetes: delivering honest risk information tied to HbA1c, negotiating a contraception-until-ready plan, stopping teratogenic medications, prescribing folate and planning aspirin, addressing severe hypoglycaemia and hypoglycaemia unawareness, and agreeing a pregnancy-readiness checklist. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

A 24-year-old with type 1 diabetes since age 8 attends a preconception clinic with her partner. She wants to start trying for a baby 'in the next few months'. HbA1c 8.8 percent (73 mmol/mol). She takes insulin degludec 22 units nightly, insulin aspart with meals, ramipril 2.5 mg daily for microalbuminuria, and rosuvastatin 10 mg nightly. She has had two episodes of severe hypoglycaemia in the last year requiring her partner to give glucagon. Retinal screening 14 months ago showed mild non-proliferative retinopathy. She says 'I have read online that diabetic women should not have babies'. You are the registrar and have 12 minutes.

Station brief

Format. Simulated-patient counselling station, approximately 12 minutes, with a partner present. A trained actor plays each role. There is no examination and no procedure. [8]

Candidate instruction. Counsel this woman about pregnancy with type 1 diabetes. Address her belief that she should not have children, give her honest and specific risk information, make the medication changes she needs now, address her severe hypoglycaemia, and agree a plan and a timeframe. Verbalise everything. [1][2]

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References8Show ledger

[1]Wahabi HA, Alzeidan RA, Bawazeer GA, et al. Preconception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis. BMC Pregnancy Childbirth, 2010.PMID 20946676
[2]Jensen DM, Korsholm L, Ovesen P, et al. Peri-conceptional A1C and risk of serious adverse pregnancy outcome in 933 women with type 1 diabetes. Diabetes Care, 2009.PMID 19265024
[3]Macintosh MC, Fleming KM, Bailey JA, et al. Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ, 2006.PMID 16782722
[4]ElSayed NA, Aleppo G, Aroda VR, et al. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2023. Diabetes Care, 2023.PMID 36507645
[5]Feig DS, Donovan LE, Corcoy R, et al. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet, 2017.PMID 28923465
[6]Widyaputri F, Khong EWC, Rogers SL, et al. Progression of diabetic retinopathy in women with pregestational diabetes during pregnancy and postpartum. Clin Exp Ophthalmol, 2024.PMID 38895754
[7]Rolnik DL, Wright D, Poon LC, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med, 2017.PMID 28657417
[8]Rudland VL, Price SAL, Callaway L ADIPS position paper on pre-existing diabetes and pregnancy. Aust N Z J Obstet Gynaecol, 2020.PMID 33135798