Implementing the guideline

SIGN Diabetes in Pregnancy

This section provides advice on the resource implications associated with implementing the key clinical recommendations, and advice on audit as a tool to aid implementation.


Implementation of national clinical guidelines is the responsibility of each NHS board, including health and social care partnerships, and is an essential part of clinical governance. Mechanisms should be in place to review care provided against the guideline recommendations. The reasons for any differences should be assessed and addressed where appropriate. Local arrangements should then be made to implement the national guideline in individual hospitals, units and practices.


Implementation of this guideline will be encouraged and supported by SIGN. The implementation strategy for this guideline encompasses the following tools and activities.


No recommendations are considered likely to reach the £5 million threshold which warrants resource impact analysis.


A first step in implementing a clinical practice guideline is to gain an understanding of current clinical practice. Audit tools designed around guideline recommendations can assist in this process. Audit tools should be comprehensive but not time consuming to use. Successful implementation and audit of guideline recommendations requires good communication between staff and multidisciplinary team working.


The guideline development group has identified the following as key points to audit to assist with the implementation of this guideline:


·     analysis of 75g OGTT and clinical outcomes in women without risk factors compared with those receiving diagnosis of GDM under the criteria recommended in this guideline


·     analysis of outcomes in women with fasting glucose levels 5.1–5.2 mmol/L and non-diagnostic one-hour or two-hour glucose values


·     analysis of outcomes in women with two-hour glucose values 7.8–9 mmol/L and non-diagnostic fasting values. (Collectively, these two points identify values which include women diagnosed using NICE and IADPSG criteria).