Pre-pregnancy glycaemic control in South West Essex: identifying postcode hotspots using a traffic light system M. Kamara, A .Ikomi, R.Khan, S.Kiss, N. Lewis, S. Mannan Background Women with diabetes who are planning to become pregnant should aim to establish good glycaemic control prior to conception and continue this throughout pregnancy (NICE CG633). Good glycaemic control reduces the risk of miscarriage, congenital anomalies, stillbirth and neonatal death. The previous national CEMACH audit in 2003 showed only 38.5% of pre-gestational diabetic women had acceptable HbA1c levels (<53mmol/mol) and the corresponding figure for South West Essex at the time was lower at 29.6%. The latest National Pregnancy in Diabetes (NPID) Audit in 2013 offered an opportunity for re-audit and benchmarking of our progress against national performance. Figure 1. Bar graph demonstrating the national percentages of women in each category of first-trimester glycaemic control, compared to the percentages in South West Essex between 2009 and 2014, and in 2013 alone- the same year the national audit was undertaken. The 3 bars on the far right demonstrate variation between postcode regions. We retrospectively analysed 1st trimester HbA1c results of 175 women with pre-gestational diabetes who had come under our care between 2009 and 2014. The readings were grouped according to the categories used in the NPID Audit Report 2013, allocating each category a colour according to a traffic light system, and then matching each patient’s HbA1c level to to their GP’s postcode. The data was analysed by generating bar graphs showing national, SW Essex and postcode bars; each bar demonstrating the percentages of women in each traffic light category. This allowed easy and instant visual comparison. Materials and methods On the map below, areas with darker shading have higher levels of deprivation, whilst areas with lighter shading have lower levels. The map shows that Basildon and Thurrock (RM and SS postcode regions) have higher levels of deprivation, whilst Brentwood (CM postcode region) is relatively well-off. Broadly speaking therefore, our data suggest that women are more likely to have poor glycaemic control if they live in a deprived region. Results Conclusion Compared to national data in 2013, South West Essex as a whole compares favourably; now recording a higher rate of acceptable 1st trimester HbA1c levels (58% vs. 35%) in contrast to 2003 when our rate was lower (29.6% vs. 38.5%). Analysis of the SW Essex regional bar graph showed marked variation between postcode regions. The CM postcode region performs the best (62%: ‘top spot’) whilst glycaemic control is worst in the RM postcode region (34%: ‘hot spot’). Analysis of the sub-regional bar graphs showed that even within the RM postcode region there was further marked variation with RM18 performing the best (72%) and RM15 the worst (18%). Matching our data to social deprivation indices suggests that women are more likely to have poor glycaemic control if they live in a deprived region. Postcode analysis using traffic light bar graphs is a simple effective alternative to complex Geographical Information Software (GIS) in isolating geographic hotspots of poor glycaemic control. We have demonstrated that, within South West Essex, marked variation in pre-pregnancy glycaemic control exists between postcode regions and that women are more likely to have poor glycaemic control if they live in a socially deprived region. In line with NPID recommendations we have shared this information through the South Essex Diabetes Network (SEDN) with a view to raising community awareness, enhancing pregnancy planning, targeting resources to the most deprived regions and re-auditing/benchmarking against national reports.   Providing safe, high quality care for our community www.basildonandthurrock.nhs.uk Figure 1. Bar graph demonstrating the national percentages of women in each category of first-trimester glycaemic control, compared to the percentages in South West Essex between 2009 and 2014, and in 2013 alone- the same year the national audit was undertaken.