Abstracts from ABCD Diabetes Update

This is the authors' abstract. We don't add key points for this paper.

This case describes a 42-year-old woman with a medical background of type 2 diabetes mellitus (T2DM) since 2012, polycystic ovarian syndrome, a history of ectopic pregnancy and left salpingectomy in 2019.She has two children, born in 2016 and 2020.She was under close follow-up during her last pregnancy and ended up with an emergency Caesarean section at 34 weeks' gestation, giving birth to a 4 kg girl.A copper IUD was inserted post-delivery.She mentioned in clinic visits afterward that her family was now complete and she was discharged back to primary care on metformin.She was referred again to the pre-conception diabetes clinic in May 2022 as she wanted to try again for a baby in the hope of having a son.Her diabetes was poorly controlled, with an HbA1c of 9.9% (85 mmol/mol).She also mentioned seeing partially digested metformin tablets in her stool.This was changed from slow-release 500 mg twice daily to immediate-release metformin 850 mg twice daily.She was advised to increase blood glucose monitoring, given lifestyle advice to improve diet and exercise and was commenced on folic acid 5 mg once daily.In August 2022, her HbA1c had improved slightly to 9.1% (76 mmol/mol) and she was commenced on Degludec 6 units and seen by the dietician and diabetes specialist nurse, who reinforced lifestyle modification advice.At the next follow-up in January 2023, her HbA1c had further improved to 7.8% (61 mmol/ mol) and she was under regular follow-up with the diabetes specialist nurse.On further enquiry, her periods were irregular and occurring every 40 days.She was started on the Freestyle Libre 2 sensor device and a day 21 progesterone level was requested, which came back < 0.6 nmol/l.She was advised not to conceive until her HbA1c had improved to 6.5% (48 mmol/mol).She was followed up in the joint pre-conception clinic in November 2023; her HbA1c was 8.5% (69 mmol/mol) and her Libre data showed high blood sugars post meals.She was commenced on short-acting insulin Fiasp before meals.This led to an improvement in time in range to 67%, and a GMI index of 7.4% (57 mmol/mol).The team had a long discussion with the patient and her family about the possible complications of pregnancy with poor diabetes control, with increased age and her previous obstetric history and, importantly, the possibility of not having a baby boy even if she conceived.However, she would still be supported throughout this journey to ensure best possible outcomes.This case tackles the common challenges and pressures faced by women of ethnic minorities under pressure from their families/society to have a boy even despite poor diabetes control.This needs attention from healthcare providers, and from society as a whole.