Prevalence and Postpartum Screening Practice for Type 2 Diabetes following GDM in King Abdulaziz Medical City: A 3-Years Retrospective Cohort Study

Aim: GDM patients were associated to develop T2DM but mostly failed to undergo screening after delivery. This study aims to examine the practice of T2DM screening and prevalence of developing T2DM among women who had GDM in King Abdulaziz Medical City (KAMC), Saudi Arabia. Methods: Retrospective study involving 642 pregnant women with GDM. Medical records on screenings conducted, delivery mode, GDM and diabetes family history were collected and investigated. Statistical analysis was conducted. Frequencies and percentages were used for categorical variables while means and SD for continuous. Chi-square and t-test were used to establish relationship of categorical and comparing two group means, respectively. Results: Patients were 98.8% Saudi nationals, mean weight, height, parity and number of pregnancies were 76.96 kg, 2.74 m, 3.37 and 1.35, respectively. Majority were obese (56.9%), SVD (56.4%) mode of delivery and good lifestyle (91.4%) as management practice. OGTT was used for screening T2DM with 0 hr fasting and 2-hrs after consuming 75g of glucose, physician ordered 6 weeks after delivery. Only 20% had screening for T2DM and 3.9% developed postpartum diabetes with high number of women not returning for ordered OGTT screening (65.6%). Significant predictors identified were parity and mode of delivery for development of T2DM, while only mode of delivery for both screening for T2DM and management of GDM.Conclusion: Low prevalence of developing T2DM but high number of women failed to follow the ordered OGTT screening. Effort on the implementation of OGTT screening for T2DM needs improvement.

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

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.

ENDOCRINOLOGY IN THE TIME OF COVID-19: Diagnosis and management of gestational diabetes mellitus

The COVID-19 pandemic has required rapid transformation and adaptation of healthcare services. Women with gestational diabetes mellitus (GDM) are one of the largest high-risk groups accessing antenatal care. In reformulating the care offered to those with GDM, there is a need to balance the sometimes competing requirement of lowering the risk of direct viral transmission against the potential adverse impact of service changes. We suggest pragmatic options for screening of GDM in a pandemic setting based on blood tests, and risk calculators applied to underlying risk factors. Alternative models for antenatal care provision for women with GDM, including targeting high-risk groups, early lifestyle interventions and remote monitoring are provided. Testing options and their timing for postpartum screening in women who had GDM are also considered. Our suggestions are only applicable in a pandemic scenario, and usual guidelines and care pathways should be re-implemented as soon as possible and appropriate.

Barriers to Postpartum Glucose Intolerance Screening in an Italian Population

Background: Gestational diabetes mellitus (GDM) is a strong risk factor for type 2 diabetes mellitus (T2D) and the postpartum period is crucial for early treatment in at-risk women. However, despite recommendations, only a fraction of women undergo a postpartum screening for glucose intolerance (ppOGTT). The present study aims to verify the reason(s) for poor adherence in our population. Research design and methods: This retrospective study includes 451 women in which GDM was diagnosed between 2015–2016. During 2017, we verified by phone interview how many women underwent ppOGTT at 6–12 weeks postpartum, as recommended by the Italian guidelines. The non-compliant women were asked about the reason(s) for failing to screen. The non-parametric Mann-Whitney test and the 2-tailed Fisher exact test were used to compare continuous and categorical features, respectively, among women performing or non-performing ppOGTT. Results: Out of 451 women with GDM diagnosis, we recorded information from 327. Only 97 (29.7%) performed ppOGTT. The remaining 230 women (70.3%) provided the following explanation for non-compliance: (1) newborn care (30.4%); (2) misunderstood importance (28.3%); (3) oversight (13.0%); (4) unavailability of test reservation in the nearest centers (10.4%); (5) normal glycemic values at delivery (8.3%); (6) discouragement by primary care physician (5.6%). Conclusions: In our population, most women with recent GDM failed to perform ppOGTT. Our results indicated that the prominent barriers could potentially be overcome.