A system-based intervention to improve postpartum diabetes screening among women with gestational diabetes

Vesco, Kimberly K.; Dietz, Patricia M.; Bulkley, Joanna E.; Bruce, F. Carol; Callaghan, William M.; England, Lucinda J.; Kimes, Terry; Bachman, Donald J.; Hartinger, Karen J.; Hornbrook, Mark C.

doi:10.1016/j.ajog.2012.08.017

Cited by 60 publications

(69 citation statements)

References 3 publications

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“…Strategies to increase return for evaluation include, besides routine counseling during pregnancy and at delivery, making reminder calls to patients after the medical staff is informed by an electronic system that the scheduled return was not met (26). In our study, a remind call would benefit not only the 48.3% women who did not return to postpartum testing, but also the 20% that came after 6 months of the delivery.…”

Section: Discussionmentioning

confidence: 87%

Postpartum glucose tolerance status 6 to 12 weeks after gestational diabetes mellitus: a Brazilian cohort

Weinert

Mastella

Oppermann

et al. 2014

Arq Bras Endocrinol Metab

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Objectives:The aims of this study were to estimate the local rate of postpartum diabetes screening after gestational diabetes mellitus (GDM) pregnancies, and to identify clinical variables associated with retesting rates and with the persistence of decreased glucose tolerance. Subjects and methods:Prospective cohort of GDM women with prenatal delivery at a specialized center, from November 2009 to May 2012. All women were advised to schedule a 6 weeks postpartum 75-g oral glucose tolerance test (OGTT). Results: Of the 209 women included, 108 (51.7%) returned to be tested with fasting plasma glucose (n = 14), OGTT (n = 93) or random glucose (n = 1). Return was associated with lower parity rate (2 vs. 3, p < 0.001) and higher pregnancy 2-h OGTT (165 vs. 155 mg/dL, p = 0.034), but not with socio-demographic characteristics. Four women (3.7%) had diabetes, 22 (20.4%) had impaired fasting glucose or impaired glucose tolerance. Persistent hyperglycemia was associated with a positive family history of diabetes (relative risk -RR 2.41, p = 0.050), diagnostic 2-h OGTT in pregnancy (RR 1.01, p = 0.045), insulin use during pregnancy (RR 2.37, p = 0.014), and cesarean section (RR 2.61, p = 0.015). Conclusions: Even though postpartum abnormalities were frequent in GDM, rates of postpartum diabetes screening were undesirably low. As no specific clinical profile defines who will adhere to postpartum testing, it is essential to encourage all women to reevaluate their glucose status, particularly those with a family history of diabetes and more severe hyperglycemia. Resultados: Das 209 mulheres arroladas na gestação, 108 (51,7%) foram avaliadas após o parto: 14 com glicemia de jejum, 93 com o TOTG e uma com glicemia ao acaso. O retorno para reavaliação foi associado com menor paridade (2 vs. 3, p < 0,001) e com glicemia de 2-h mais elevada no TOTG diagnóstico (165 vs. 155 mg/dL, p = 0,034). Diabetes foi diagnosticado em quatro mulheres (3,7%) e pré-diabetes em 22 (20,4%). Análise multivariada evidenciou que a história familiar de diabetes (risco relativo -RR 2,41, p = 0,050), a glicemia de 2 horas no TOTG da gestação (RR 1,01, p = 0,045), o uso de insulina na gestação (RR 2,37, p = 0,014) e a taxa de cesariana (RR 2,61, p = 0,015) foram os fatores associados à persistência da hiperglicemia. Conclusões: O retorno para reavaliação foi baixo, embora as alterações glicêmicas tenham sido frequentes. Como não houve fatores que indiquem quais mulheres retornarão, estratégias para aumentar a adesão são necessárias, especialmente quando há história familiar ou o DMG foi mais grave. Arq Bras Endocrinol Metab. 2014;58(2):197-204 Descritores Diabetes gestacional; reavaliação pós-parto; DMG; diabetes tipo 2; teste oral de tolerância à glicose ¹ Programa de Pós-graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul

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Section: Discussionmentioning

confidence: 87%

Postpartum glucose tolerance status 6 to 12 weeks after gestational diabetes mellitus: a Brazilian cohort

Weinert

Mastella

Oppermann

et al. 2014

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

show abstract

“…Even during the short period of this study, local guidelines changed three times [25][26][27], with some variation from national guidelines [28], and have subsequently been revised twice [76], broadly in line with revised national guidelines [37]. Recent studies show that comparatively simple 'interventions' can improve postpartum glucose screening rates [77], including physician reminders [78], system changes [31,73,79], proactive postpartum care plans [80], antenatal education [81], registers [82], clinical protocols, electronic records and patient reminders [83]. One study in the United States showed stark comparisons between high rates of early postpartum Papanicolaou (Pap) testing for cervical cancer (94 %), and concurrent low rates of postpartum glucose screening among women with GDM (37 %) [84].…”

Section: Discussionmentioning

confidence: 98%

Low Rates of Postpartum Glucose Screening Among Indigenous and non-Indigenous Women in Australia with Gestational Diabetes

Chamberlain

McLean

Oats

et al. 2014

Matern Child Health J

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Women with gestational diabetes have a high risk of type 2 diabetes postpartum, with Indigenous women particularly affected. This study reports postpartum diabetes screening rates among Indigenous and non-Indigenous women with gestational diabetes, in Far North Queensland, Australia. Retrospective study including 1,012 women with gestational diabetes giving birth at a regional hospital from 1/1/2004 to 31/12/2010. Data were linked between hospital records, midwives perinatal data, and laboratory results, then analysed using survival analysis and logistic regression. Indigenous women had significantly longer times to first oral glucose tolerance test (OGTT) [hazards ratio (HR) 0.62, 95 % confidence interval (CI) 0.48-0.79, p < 0.0001) and 'any' postpartum glucose test (HR 0.81, 95 % CI 0.67-0.98, p = 0.03], compared to non-Indigenous women. Postpartum screening rates among all women were low. However, early OGTT screening rates (<6 months) were significantly lower among Indigenous women (13.6 vs. 28.3 %, p < 0.0001), leading to a persistent gap in cumulative postpartum screening rates. By 3 years postpartum, cumulative rates of receiving an OGTT, were 24.6 % (95 % CI 19.9-30.2 %) and 34.1 % (95 % CI 30.6-38.0 %) among Indigenous and non-Indigenous women, respectively. Excluding OGTTs in previous periods, few women received OGTTs at 6-24 months (7.8 vs. 6.7 %) or 2-4 years (5.2 vs. 6.5 %), among Indigenous and non-Indigenous women, respectively. Low rates of postpartum diabetes screening demonstrate that essential 'ongoing management' and 'equity' criteria for population-based screening for gestational diabetes are not being met; particularly among Indigenous women, for whom recent guideline changes have specific implications. Strategies to improve postpartum screening after gestational diabetes are urgently needed.

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“…case managers, reminders, provider education) and shown benefit. 15,19 It is important to recognize that the postpartum period is a time of transition between providers. Perceived barriers for not completing postpartum testing include not attending postpartum visits/being lost to follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Several studies to date have shown that use of an automatic reminder system improves postpartum diabetes screening rates. [9][10][11][12][13][14][15] Identification of clinical predictors of diabetes testing is required to target high risk populations, create effective models of patient care postpartum and develop interventional strategies. We designed this study to address two important clinical questions: (1) do maternal characteristics, obstetrical factors, GDM care delivery or utilization of health services postpartum predict if a woman with GDM will complete a screening test in the first year postpartum?…”

Section: Introductionmentioning

confidence: 99%

Clinical predictors for diabetes screening in the first year postpartum after gestational diabetes

et al. 2014

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Background: Postpartum screening for diabetes in women with gestational diabetes (GDM) improves with use of reminder systems. Our primary objective was to identify predictors of diabetes screening in the first year after delivery. Methods: A retrospective study was performed of 556 women with GDM who received outpatient prenatal care between 2007 and 2009. A mailed reminder system was utilized at two sites. Rates of postpartum glucose testing at 6 and 12 months postpartum were measured. Results: Site of care and non-smoking status were identified as the only predictors of postpartum diabetes screening (p50.001 and p ¼ 0.02, respectively). Rates of OGTT completion at one year (38% vs. 19% p50.001) were higher in women who attended clinics with postpartum reminders. Conclusions: The site of diabetes care in pregnancy is a major predictor of adherence to diabetes screening postpartum. Health care delivery should be considered in the development of strategies to increase screening rates.

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A system-based intervention to improve postpartum diabetes screening among women with gestational diabetes

Cited by 60 publications

References 3 publications

Postpartum glucose tolerance status 6 to 12 weeks after gestational diabetes mellitus: a Brazilian cohort

Postpartum glucose tolerance status 6 to 12 weeks after gestational diabetes mellitus: a Brazilian cohort

Low Rates of Postpartum Glucose Screening Among Indigenous and non-Indigenous Women in Australia with Gestational Diabetes

Clinical predictors for diabetes screening in the first year postpartum after gestational diabetes

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