Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 18

18 - SCREENING FOR DIABETES MELLITUS IN PATIENTS WITH A HISTORY OF GESTATIONAL DIABETES MELLITUS: AWARENESS OF THE RECOMMENDED GUIDELINES

Saturday, Apr 27
11:00 AM – 11:30 AM

Objective :

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.  


Methods :

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. 


Results :

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.    


Discussion :

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.

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Abhilasha Singh

Resident
Medstar Health Internal Medicine
Baltimore, Maryland

Resident in training.

Ariane C. Davis

Fellow
Union Memorial Hospital

Fellow in training.

Pamela R. Schroeder

Program Director, Endocrinology and Metabolism Fellowship
Union Memorial Hospital
Baltimore, Maryland

Program Director