Inadequate post-partum screening for type 2 diabetes in women with previous gestation diabetes mellitus: a retrospective audit of practice over 17 years.

Ward, Rebecca J.; Fryer, Anthony A.; Hanna, Fahmy W.; Spencer, Nathaniel; Mahmood, Madia; Wu, Pensee; Heald, Adrian H.; Duff, Christopher J.

Abstract

INTRODUCTION: Women with gestational diabetes (GDM) are at greatly increased risk of type 2 diabetes (T2DM). The UK guidance recommends screening for T2DM at around 6 weeks post-partum and annually thereafter. We evaluated conformity to this guidance in two separate time periods. METHODS: The proportion of tests performed within guidance was assessed using longitudinal plasma glucose and glycated haemoglobin data in two cohorts (1999-2007, n=251; 2015-2016, n=260) from hospital records on women previously diagnosed with GDM. RESULTS: In the 1999-2007 and 2015-2016 cohorts, 59.8% and 35.0% of women had the recommended post-partum testing, respectively (p<0.001); just 13.5% and 14.2%, respectively, underwent the first annual test on time. During long-term follow-up of the 1999-2007 cohort (median follow-up: 12.3 years), the proportion of women tested in any given year averaged 34.2% over a 17-year period; there was a progressive decline in the proportion of women receiving a yearly test with time since delivery (p=0.002). Over the follow-up period, 85 women from the 1999-2007 cohort developed blood test results in the diabetic range with a median time to presumed DM diagnosis of 5.2 years (range 0.11-15.95 years). Kaplan-Meier analysis showed that 18.8% of women had blood test results in the diabetes range by 5 years and 37.8% by 10 years post-partum. CONCLUSIONS: Despite high profile guidelines and a clear clinical rationale to screen women with a past diagnosis of GDM, many women did not receive adequate screening for T2DM, both in the short- and long-term. This suggests alternative approaches are needed to ensure effective follow-up of this high-risk group. To have an impact, interventions need to be tailored to a young, generally healthy group in which traditional approaches to follow-up may not be best suited.

Citation

Ward, R. J., Fryer, A. A., Hanna, F. W., Spencer, N., Mahmood, M., Wu, P., …Duff, C. J. (2021). Inadequate post-partum screening for type 2 diabetes in women with previous gestation diabetes mellitus: a retrospective audit of practice over 17 years. International Journal of Clinical Practice, e14447 - ?. https://doi.org/10.1111/ijcp.14447

• Journal Article Type: Article
• Acceptance Date: Jun 21, 2021
• Online Publication Date: Jun 9, 2021
• Publication Date: 2021-09
• Journal: International Journal of Clinical Practice
• Print ISSN: 1368-5031
• Publisher: Wiley
• Pages: e14447 - ?
• DOI: https://doi.org/10.1111/ijcp.14447
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/ijcp.14447