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