Introduction: Gestational diabetes (GDM) confers an increased risk of type 2 diabetes (T2D). Women with GDM should have an oral glucose tolerance test (OGTT) 6-12 weeks after delivery. The literature suggests poor uptake of this test, with variable efficacy of written and technology-based interventions aimed at improving screening uptake.
Hypothesis: An individualised reminder improves uptake of post-partum screening in women with GDM and identifies pre-diabetes and diabetes.
Method: In 2013-15, women newly diagnosed with GDM attending an endocrine-antenatal clinic were provided with a pathology form for post-partum OGTT. Education during pregnancy reinforced the effectiveness of post-partum screening and lifestyle intervention. After delivery a personalised reminder letter was sent to selected patients for whom no glucose results were available by 12 weeks. Results were assessed for women who delivered between 2013-14 and 2014-15.
Results: Over the last decade there has been a two to three-fold increase in the number of women with GDM (n=137 to 345/year). In 2004-5, 56% (67/137) attended screening within 12-months of delivery. In 2013-14 and 2014-15, the proportion of women attending screening <3-months post-partum were 50% (126/252) and 45.5% (157/345) respectively. Following the reminder letter, this increased to 58.3% (147/252) and 62.02% (214/345) by 12-months. A high proportion of tests performed <3-months were positive: 7.9% (10/126) and 5.7% (9/157). The percentage of women diagnosed with abnormal glucose metabolism increased to 8.8% (13/147) and 6.5% (14/214) at 12-months post-partum.
Discussion: Women who attend glucose testing <3-months post-partum have a 1 in 15 chance of identifying abnormal glucose metabolism; this increased following a selective reminder to 1 in 13 women. Identification allows early intervention in this high-risk group; however those who do not attend fail to benefit. Novel strategies should be developed to target the non-attending women in order to reduce their risk of recurrent GDM and T2D.