Recent notice to shield (Feb 2021) and history of gestational diabetes

[HelloViroids]

This has popped up on a few other threads and had blindsided me today so thought I’d make a thread in case others want to discuss.

I had gestational diabetes but have since been tested for type 2 diabetes and don’t have it. I know my risk of type 2 is increased though. I’ve now have notice to shield and (separately) link to book vaccine.

I have no other significant risk factors (overweight but not obese, ethnicity more risky - but NOT asthma or any other respiratory conditions or similar), so I am assuming the GD must be the reason I am now being treated as CEV. Someone pointed out on another thread that gestational diabetes is a factor in the algorithm being used to add people to the list (digital.nhs.uk/coronavirus/risk-assessment) - but I had thought that would be current GD not historic?!

Just wondered if anyone else has been surprised by this - or if anyone has had GD but NOT been told to shield? I wasn’t expecting lockdown to get worse at this point

@TheWristBoundLatexBitch What about? I feel a bit nervous too.

Thanks @doireallyneedaname .. not that then!

Getting more baffled by the hour, as well as concerned that I am not on a list I should be on. I've been shielding essentially anyway because I lead a dull life and my husband is convinced I am going to die from COVID so doesn't even let me do the shopping anymore... but if I am genuinely at risk I would like to get my vaccine please!

@Horizons83 I don’t think we’ll ever know. I think it’s a “computer says so” thing.

Multiple factors, area, BMI, age, and I suspect previous medical records. “Severe mental health disorders” are on the list and I have been in and out of therapy for years, tried multiple prescription meds for short periods of time, and whilst I never had an official diagnosis of anything, I did see a psych on the NHS who could have put anything in the notes that could trigger that too. It’s either too sophisticated for us to understand, or it’s gone slightly wrong.

Well I have had GD multiple times, I had no letter and the GP has confirmed I don't have to shield. There must be other factors on people's medical records. Even if they think there isn't.

I haven’t received a letter or email either. I’ve had GD in my first pregnancy in 2017 but I didn’t have it in my second pregnancy in 2020. I have a BMI over 30 but no other issues I’m aware of.

The link to radio 2 above didn’t work for me, but this link to the programme should work www.bbc.co.uk/sounds/play/m000sblg they do talk specifically about GD

[quote doireallyneedaname]@TheWristBoundLatexBitch What about? I feel a bit nervous too.[/quote]
I'm nervous of needles in general.

I had diet controlled GD with my DS and haven't received letter. I'm asthmatic but healthy BMI. HB1AC is up to date and fine.

I'm currently pregnant again and so far haven't developed it. Has anyone who is pregnant received the letter?

I'm very confused but it doesn't seem to be an error. From what I've read, coronavirus is causing some people to develop diabetes and having had GD you're much more predisposed to developing it anyway. I'm not sure how their algorithm works though as it seems very random.

This is really stressing me out. We were going to TTC again. Maybe not.

It doesn't make any sense.
Why is someone with historic GD & 1 other risk factor (although the additional risk factor doesn't seem to apply to all 🤷🏻‍♀️) classed as CEV when a T1 isn't?
It doesn't make sense.

Are you? I had GD 14 years ago and have never been checked! Is it by postcode too?

Someone just sent me this from the QCovid thing. Still in the dark about what my ‘other factors’ are ...

Take a look at Twitter @ParthaKar who is the NHS clinical assoc director for diabetes. He provided the data Re diabetes risk factors back in April.
He is desperately seeking clarification and is just as confused as everyone else.
He suspects they have used the wrong code as it absolutely doesn't make sense that someone who is at increased risk of developing a disease is a higher risk than someone who has it already.
It can't be right.

digital.nhs.uk/coronavirus/risk-assessment/population#health-conditions-and-treatments

Have just been sent this and it now talks about GD under diabetes.

Fascinating reading that twitter and seeing it all play out real time.

My initial fear when the GP on one of these threads mentioned removing flags my closing the GD record was that if GD had widespread discrepancies in how it was recorded then the data going into the model could be flawed. I hope this is not the case. If for example 50%of historic GD cases have been aggregated with type 2 data as they were still recorded as open and actually type 2 carries risk and GD doesn't then
A) Gd risk could be being overstated and
B) type 2 risk could be being understated
Or the other way round if for some reason the risk lies with historic gd and not type 2.

This data analysis exercise was always very ambitious, and inconsistent data recording a massive risk. I guess its another thing which will serve a purpose population level, but at an individual level may have some illogical consequences .

This is speculation, there may be no data issues, and some unknown (to us) reason why GD seems such a high risk factor.

I’m beginning to think postcode must be quite significant. I’ve just put my data in again. With my postcode my risk of death is 1 in 7407. With no postcode included it’s 1 in 4854.

So maybe GD and postcode is enough to trigger something for some people, but not everyone.

Pretty depressing given that my risk without the GD is 1 in 62500. That’s a terrifying change in risk with no explanation. And having a ‘safe’ postcode doesn’t reassure me. Just now makes me anxious when I wasn’t before.

I think this is why the new shielding letters say "you may be at high risk" not "you are at high risk". I would take comfort in the fact they have erred on being over cautious so it is more likely that someone has erroneously been asked to shield than has been missed off the list.

If it has been done by data analysis not by understanding pathologies it is likely that some trends have been thrown up that aren't understood. This could be data/model limitations or it could be genuine trends.

Everyone does need to remember that individual risk is still low. Try not to panic, and hopefully soon there will be clarity.

And also: if your records do not show your ethnicity this could also bump up your score:

If a person’s ethnicity is not available, a value equal to the ethnicity with the highest risk is used by default. This is in line with the precautionary approach to overestimate rather than underestimate risk.

I've had the letter and email, took me by surprise before being ignored.
I had insulin controlled GD with dc2, who is now over a year old, and my BMI is north of 35 thanks to lockdown snacking but was below last time weight was measured for my records. I'm assuming I've been lumped in because I never got the follow up test for the all clear of GD so no doubt still have a diabetic flag or whatever on my medical records. Also have PCOS which is another risk factor for t2 and had metformin to treat pcos related infertility so maybe that previous prescription has been factored in 🤷🏼‍♀️

Makes little difference to me personally, don't really see the point a year in and past the second peak.

No shielding letter for me. I had GD in my final two pregnancies, needing insulin. BMI is over 30. Also am coeliac and my asthma is bad enough to put me in group 6 alone.
So a few high risk factors there but I am in group 6 as asked the administrator at my Gp when had to contact about something else.

@Horizons83

And also: if your records do not show your ethnicity this could also bump up your score:

If a person’s ethnicity is not available, a value equal to the ethnicity with the highest risk is used by default. This is in line with the precautionary approach to overestimate rather than underestimate risk.

Same with BMI - apparently if BMI is not available they use a BMI of 31. As that is the median BMI in the UK.

Not really a logical presumption though, since presumably those with no BMI on file are more likely to have no weight problem?

I'm more concerned as to why I have never Had these yearly tests you all mention for 14 years since I had GD! Didn't know until today! Anyone else?

@LouLouMcGeough

I'm more concerned as to why I have never Had these yearly tests you all mention for 14 years since I had GD! Didn't know until today! Anyone else?

I've not had anything in the last 8 years either. I do remember having a test a year after my previous three, but number four, nothing.

I was told that I needed an annual blood test after my GD pregnancy in 2016. They advised me to book it every year around my son's birthday to remind me but I have never been asked/called by the GP, I just have to ring and book it myself.

twitter.com/RCObsGyn/status/1362807733892833284