Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance with onset or first recognition during pregnancy. Women with GDM are at risk for development of diabetes; therefore, post-partum screening is important for timely diagnosis and prevention of diabetes-related complications. We hypothesized that physicians are not aware of the guidelines for postpartum screening of patients with a history of GDM and that these patients are under-screened for DM post-partum. A prior chart review of 692 patients with GDM revealed that only 1.2% of patients had documented initial screening in the initial postpartum period (3-6 weeks). Of the women who underwent initial screening, only 1 underwent appropriate screening with 2-hour oral glucose tolerance test (OGTT). As the majority of patients were either not screened or inappropriately screened, we followed this study with a survey to assess the awareness among residents in our teaching hospital regarding post-GDM screening.
Data were gathered through a voluntary, anonymous electronic survey and included residents in the Medstar Health Internal Medicine residency program. The initial survey consisted of “yes” or “no” questions regarding post-GDM screening. The expanded survey that we are currently conducting is also anonymous and voluntary but in a multiple-choice format.
Out of 100 survey responses, 91% correctly answered to screen patients postpartum. However, 61% of providers considered A1C to be an appropriate screening test postpartum, which is not in accordance with the American Diabetes Association (ADA) recommendations. Further repeat testing every 3 years for normal or annually for impaired glucose tolerance was answered correctly by 76% and 68%, respectively.
The results of the survey revealed that a substantial number of physicians were unaware of the screening guidelines. From our prior study, we know that the majority of women do not undergo appropriate screening in the post-partum period. The data from this survey helped us identify the knowledge gap and will serve as a quality improvement project to raise awareness and improve the practice patterns of resident physicians in primary care settings.
Conclusion : As approximately 50% of mothers who are diagnosed with GDM progress to overt DM, the ADA currently recommends screening at 4-12 weeks post-partum via 75-gram 2-hour OGTT. Further monitoring is done annually for impaired fasting glucose or every 3 years life-long for normal results. As these women are at increased risk of progression to overt diabetes, cardiovascular disease and recurrent GDM, it is imperative to identify and screen these high-risk patients.
Medstar Health Internal Medicine
Resident in training.