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Cited by 51Gestational Diabetes Research and ManagementDiabetes Management and ResearchHyperglycemia and glycemic control in critically ill and hospitalized patients

Managing hyperglycaemia during antenatal steroid administration, labour and birth in pregnant women with diabetes – an updated guideline from the Joint British Diabetes Society for Inpatient Care

Dashora, Umesh, Levy, Nicholas, Dhatariya, Ketan, Willer, Nina, Castro, Erwin, Murphy, Helen R., the Joint British Diabetes Societies In Patient group·2022·Diabetic Medicine
DOI 10.1111/dme.14744
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Abstract

This article summarises the Joint British Diabetes Societies for Inpatient Care guidelines on the management of glycaemia in pregnant women with diabetes on obstetric wards and delivery units, Joint British Diabetes Societies (JBDS) for Inpatient Care Group, ABCD (Diabetes Care) Ltd. The updated guideline offers two approaches – the traditional approach with tight glycaemic targets (4.0–7.0 mmol/L) and an updated pragmatic approach (5.0–8.0 mmol/L) to reduce the risk of maternal hypoglycaemia whilst maintaining safe glycaemia. This is particularly relevant for women with type 1 diabetes who are increasingly using Continuous Glucose Monitoring (CGM) and Continuous Subcutaneous Insulin Infusion (CSII) during pregnancy. All women with diabetes should have a documented delivery plan agreed during antenatal clinic appointments. Hyperglycaemia following steroid administration can be managed either by increasing basal and prandial insulin doses, typically by 50% to 80%, or by adding a variable rate of intravenous insulin infusion (VRIII). Glucose levels, either capillary blood glucose or CGM glucose levels, should be measured at least hourly from the onset of established labour, artificial rupture of membranes or admission for elective caesarean section. If intrapartum glucose levels are higher than 7.0 or 8.0 mmol/L on two consecutive occasions, VRIII is recommended. Hourly capillary blood glucose rather than CGM glucose measurements should be used to adjust VRIII. The recommended substrate fluid to be administered alongside a VRIII is 0.9% sodium chloride solution with 5% glucose and 0.15% potassium chloride (KCl) (20 mmol/L) or 0.3% KCl (40 mmol/L) at 50 ml/hr. Both the VRIII and CSII rates should be reduced by at least 50% after delivery.

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  • Recommendations for insulin dosing during glucocorticoid therapy in people with type 1 diabetes remain unclear and inconsistent.

    “While certain guidelines offer insulin adjustment recommendations for GC therapy in PWT1D, they remain inconsistent and lack consistency, underscoring the need for a more evidence‐based approach to individualised management. 19 , 24 , 25 , 26 , 27 , 28 , 29 , 30”

    From A systematic review of glucocorticoid use in type 1 diabetes: Glycaemic effects and clinical management strategies (2026) · cites this paper as [25]

  • Only a handful of guidelines, including Diabetes Canada and the Joint British Diabetes Societies, attempt to address specific subgroups such as pregnant individuals or oncology patients.

    “only a handful of guidelines, including Diabetes Canada 26 and Joint British Diabetes Societies, 25 , 69 attempt to address specific subgroups, such as pregnant individuals or oncology patients.”

    From A systematic review of glucocorticoid use in type 1 diabetes: Glycaemic effects and clinical management strategies (2026) · cites this paper as [25]

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Authors
Dashora, U., Levy, N., Dhatariya, K., Willer, N., Castro, E., Murphy, H. R., & the Joint British Diabetes Societies In Patient group
Affiliations
  • Conquest Hospital (GB)
  • West Suffolk Hospital (GB)
  • University of East Anglia (GB)
  • Norfolk and Norwich University Hospital (GB)
Corresponding author
Dashora, Umesh
ORCID
Venue
Diabetic Medicine
Publisher
Wiley
Published
2021-12-07
Volume
39
Issue
2
Pages
e14744-e14744
ISSN
  • 0742-3071 (ISSN-L)
  • 1464-5491
DOI
10.1111/dme.14744
OpenAlex
W3216417331
Cited by
51
References
26
Citations by year
2026: 10 · 2025: 16 · 2024: 13 · 2023: 5 · 2022: 7
FWCI
5.67
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Diabetic Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute for Health and Care Research (16/35/01)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Keywords
hyperglycemia in pregnancy, gestational diabetes mellitus, type 1 diabetes in pregnancy, antenatal corticosteroids, continuous glucose monitoring, insulin pump therapy, glycemic targets, delivery planning, obstetric care
MeSH terms
Blood Glucose, Cesarean Section, Diabetes Mellitus, Female, Glucocorticoids, United Kingdom, Hospitals, Group Practice, Humans, Infant, Newborn, Inpatients, Pregnancy, Pregnancy in Diabetics, Prenatal Care, Societies, Medical, Blood Glucose Self-Monitoring, Disease Management, Delivery, Obstetric

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