Results of the first recorded evaluation of a national gestational diabetes mellitus register: Challenges in screening, registration, and follow-up for diabetes risk

Abstract

ObjectiveGestational Diabetes Mellitus (GDM) increases the risk of type 2 diabetes. A register can be used to follow-up high risk women for early intervention to prevent progression to type 2 diabetes. We evaluate the performance of the world’s first national gestational diabetes register.Research design and methodsObservational study that used data linkage to merge: (1) pathology data from the Australian states of Victoria (VIC) and South Australia (SA); (2) birth records from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM, VIC) and the South Australian Perinatal Statistics Collection (SAPSC, SA); (3) GDM and type 2 diabetes register data from the National Gestational Diabetes Register (NGDR). All pregnancies registered on CCOPMM and SAPSC for 2012 and 2013 were included–other data back to 2008 were used to support the analyses. Rates of screening for GDM, rates of registration on the NGDR, and rates of follow-up laboratory screening for type 2 diabetes are reported.ResultsEstimated GDM screening rates were 86% in SA and 97% in VIC. Rates of registration on the NGDR ranged from 73% in SA (2013) to 91% in VIC (2013). During the study period rates of screening at six weeks postpartum ranged from 43% in SA (2012) to 58% in VIC (2013). There was little evidence of recall letters resulting in screening 12 months follow-up.ConclusionsGDM Screening and NGDR registration was effective in Australia. Recall by mail-out to young mothers and their GP’s for type 2 diabetes follow-up testing proved ineffective.

Establishment of a sentinel surveillance network for sexually transmissible infections and blood borne viruses in Aboriginal primary care services across Australia: the ATLAS project

“…We explored several different commercially-available data extraction tools-including software developed by the Improvement Foundation (12) and Pen CS (13)-before opting for the University of Melbourne's GRHANITE tm software (14). GRHANITE offered significant advantages over other software products including; compatibility with most of the EMR used in the ACCHS sector, capacity to deliver line-listed data, a substantial history of use by other sexual health research and surveillance projects (15)(16)(17), and best-practice approaches to patient deidentification and data encryption (9,18).…”

“…Diagnosis rates of chlamydia and gonorrhoea are reported at between 3-5 and 3-30 times higher than those for non-Aboriginal Australians, respectively. An ongoing syphilis outbreak spanning four jurisdictions and amassing over 2,400 cases since 2011 continues to predominantly affect Aboriginal heterosexual people aged [16][17][18][19][20][21][22][23][24][25][26][27][28][29] years living in remote communities of Australia (4). Further, increasing notification rates of both hepatitis C and HIV among Aboriginal people are of concern, given that over the last five years, diagnoses rates among non-Aboriginal people have stabilised or decreased (3).…”

Establishment of a sentinel surveillance network for sexually transmissible infections and blood borne viruses in Aboriginal primary care services across Australia: the ATLAS project

“…Most EMR require the use of third-party software to perform the extraction and delivery of relevant data in a standardised manner. We explored several different tools before opting for the University of Melbourne's GRHANITE tool (28), software that has been successfully used in other sexual health research and surveillance projects (29)(30)(31) and which utilises best-practice approaches to patient deidentification and data encryption (16,32). For our network, the hash-based deidentification process was a key feature as it is thought to be more secure than the Australian Government's SLK581 (33), retaining no element of personal information in the hashed identifier, yet still facilitates person-based linkage across the ATLAS network irrespective of the EMR from which the data originate.…”

Nomograms for incident risk of post‐partum type 2 diabetes in Chinese women with gestational diabetes

“…Uptake of follow‐up testing and of lifestyle interventions by women who have completed their pregnancy and in many cases have returned to normoglycaemia has also been low as shown by Australian studies which captured women with GDM and prompted follow‐up testing …”

“…9 Uptake of follow-up testing and of lifestyle interventions by women who have completed their pregnancy and in many cases have returned to normoglycaemia has also been low as shown by Australian studies which captured women with GDM and prompted follow-up testing. 9,10 All this important work to identify those women with GDM who will develop T2D and to effectively follow them up with practical interventions which reduce progression to T2D needs to continue. This is clearly challenging and will also require country-specific approaches as Li Weiqin and colleagues state.…”