Navigating a ‘Perfect Storm’ on the Path to Prevention of Type 2 Diabetes Mellitus After Gestational Diabetes: Lessons from Patient and Provider Narratives

McCloskey, Lois; Sherman, Marlena L; John, Meryl St; Siegel, Hannah; Whyte, John; Iverson, Ronald E.; Lee-Parritz, Aviva; Bernstein, Judith

doi:10.1007/s10995-018-2649-0

Cited by 25 publications

(45 citation statements)

References 31 publications

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“…‘We present it like “okay, you have GDM, it’s a potential risk, but it’s not technically affected the baby per se.” I think we may be part of it […] that we maybe simplify it so they don’t see it as “oh it’s not going to kill my baby right”. ’ (community nurse midwife) 20 …”

Section: Resultsmentioning

confidence: 99%

Barriers to postpartum diabetes screening: a qualitative synthesis of clinicians’ views

et al. 2021

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Background: Gestational diabetes (GDM) is an important risk factor for developing type 2 diabetes (T2DM) later in life. Postpartum screening provides an opportunity for early detection and management of T2DM, but uptake is poor. Aim: To explore barriers to screening from clinicians’ perspectives to guide future interventions to increase uptake. Design and Setting: Systematic review and qualitative synthesis. Method: We assessed qualitative studies included in a previous review, then searched five electronic databases from 2013 to May 2019 for qualitative studies reporting clinicians’ perspectives on postpartum glucose screening after GDM. Study quality was assessed against the Critical Appraisal Skills Programmes checklist. Qualitative data from the studies were analysed using thematic synthesis. Results: We included nine studies, containing views from 187 clinicians from both community and hospital care. Three main themes were identified: difficulties in handover between primary and secondary care (ambiguous roles and communication difficulties), short-term focus in clinical consultations (underplaying risk so as not to overwhelm patients and competing priorities) and patient-centric barriers. Conclusion: We identified barriers to diabetes screening at both system and individual levels. At the system level, clarification of responsibility for testing among healthcare professionals and better systems for recall are needed. These could be achieved through registers, improved clinical protocols, and automatic flagging and prompts within electronic medical records. At the individual level, clinicians should be supported to prioritise the importance of screening within consultations and better educational resources made available for women. Making it more convenient for women to attend may also facilitate screening.

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Section: Resultsmentioning

confidence: 99%

Barriers to postpartum diabetes screening: a qualitative synthesis of clinicians’ views

et al. 2021

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“…Despite these alarming statistics, women worldwide with a history of GDM continue to have low rates (20%-55%) of recommended follow-up glucose tolerance testing and monitoring (Shah, Lipscombe, Feig, & Lowe, 2011). In the United States, this gap is further exacerbated by racial and ethnic inequities in health care (Martin et al, 2018;McCloskey et al, 2019b). Black, Latina, and Native women are least likely to be tested and followed despite their disproportionate risk of type 2 diabetes (Jones, Hernandez, Edmonds, & Ferranti, 2019).…”

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confidence: 99%

Bridging the Chasm between Pregnancy and Health over the Life Course: A National Agenda for Research and Action

McCloskey¹,

Bernstein²,

Amutah-Onukagha³

et al. 2021

Women's Health Issues

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“…Currently, many women serviced by the ESC experience a gap in care following the end of maternity care as they transition back to their primary care provider (McCloskey et al., 2019). The absence of a clear care continuum is especially problematic for many of these women who currently lack insurance or will lose Medicaid coverage within several months of delivery.…”

Section: Discussionmentioning

confidence: 99%

A Florida public health‐based endocrine clinic for low‐income pregnant women with diabetes

LaManna

Quelly

Stahl

et al. 2020

Public Health Nursing

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Objectives To evaluate pregnancy outcomes of low‐income women with diabetes‐complicated pregnancies who received care from an embedded, public health‐based endocrine specialty clinic (ESC) in Florida. Design This program evaluation used retrospective chart data to analyze client characteristics, pre‐program and during‐program glycemic control, and pregnancy outcomes of women enrolled in a prenatal ESC. Sample Ninety‐two low‐income, pregnant women with type 1/type 2 diabetes or gestational diabetes (GDM) comprised this racially/ethnically diverse sample. Variables/Analysis Neonatal outcomes included frequencies of prematurity, hypoglycemia, hyperbilirubinemia, and birth weight‐for‐gestational‐age categories. Differences in maternal HbA1C at program entry and mean HbA1C during ESC care were determined by a Wilcoxon and paired sample t test. Results HbA1C levels during ESC care (6.9 ± 1.4) were less than program entry HbA1C levels (7.9 ± 1.8) for women with pregestational diabetes (Z = −3.364, p = .001). Among women with GDM, mean HbA1C values during ESC care (5.5 ± 0.4) did not significantly differ (t(51) = −0.532, p > .05) from program entry HbA1C levels (5.5 ± 0.5), suggestive of glycemic goal achievement. No neonatal hypoglycemia or hyperbilirubinemia cases were observed in both groups. Approximately 11% of births were preterm, and 16% of neonates were large‐for‐gestational‐age. Conclusions A public health‐based ESC for low‐income pregnant women with diabetes may positively affect pregnancy outcomes.

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Navigating a ‘Perfect Storm’ on the Path to Prevention of Type 2 Diabetes Mellitus After Gestational Diabetes: Lessons from Patient and Provider Narratives

Cited by 25 publications

References 31 publications

Barriers to postpartum diabetes screening: a qualitative synthesis of clinicians’ views

Barriers to postpartum diabetes screening: a qualitative synthesis of clinicians’ views

Bridging the Chasm between Pregnancy and Health over the Life Course: A National Agenda for Research and Action

A Florida public health‐based endocrine clinic for low‐income pregnant women with diabetes

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