252: Patient counseling increases postpartum follow-up in women with gestational diabetes mellitus

Abstract

ObjectiveTo evaluate the efficacy of a campaign to increase the rates of postpartum follow-up in women with gestational diabetes mellitus.Study DesignA retrospective cohort study of all women diagnosed with gestational diabetes mellitus (GDM) who delivered at our institution 2002-2009 was conducted. Primary outcome was obtaining postpartum (PP) diabetes testing. The group was dichotomized into one cohort that delivered 2002-2007 and the other that delivered 2007-2009. Prior to 2007, GDMs were advised to obtain PP diabetes testing by their PP providers. In 2007, all women received a counseling session at their 37-38 week visit: a registered nurse supplied patients with written and verbal information about PP glucose testing. Univariate and multivariable statistical tests were utilized.ResultsThe overall PP diabetes testing frequency for women delivering after counseling was instituted was 53%, compared to 33% for women delivering prior to the implementation of counseling (p<0.001). When examined by race/ethnicity, Whites (28 to 53%, p<0.001), Latinas (15 to 50%, p<0.001), and Asians (43 to 59%, p=0.005) had increased PP diabetes testing. However, there was a nonsignificant decrease in African-American follow-up, 28% to 17% (p=0.414). Within the 2007-2009 cohort, positive predictors for follow-up included maternal age 35 and insulin use. The sole negative predictor was preterm delivery (Table).Tabled 1Predictors of increased postpartum diabetes testingCharacteristicaOR95%CICounseling Intervention2.061.49-2.86White1.00—African-American0.670.34-1.31Latina0.690.41-1.16Asian1.721.21-2.43Age ≥351.190.87-1.62Insulin Use2.131.54-2.95Preterm Birth0.800.68-0.94 Open table in a new tab ConclusionGDM often precedes the onset of type 2 diabetes. We have demonstrated that a simple, one-on-one counseling session with patients conducted several weeks prior to delivery increases the follow-up diabetes testing rate. Further efforts are needed to obtain universal testing in these women. ObjectiveTo evaluate the efficacy of a campaign to increase the rates of postpartum follow-up in women with gestational diabetes mellitus. To evaluate the efficacy of a campaign to increase the rates of postpartum follow-up in women with gestational diabetes mellitus. Study DesignA retrospective cohort study of all women diagnosed with gestational diabetes mellitus (GDM) who delivered at our institution 2002-2009 was conducted. Primary outcome was obtaining postpartum (PP) diabetes testing. The group was dichotomized into one cohort that delivered 2002-2007 and the other that delivered 2007-2009. Prior to 2007, GDMs were advised to obtain PP diabetes testing by their PP providers. In 2007, all women received a counseling session at their 37-38 week visit: a registered nurse supplied patients with written and verbal information about PP glucose testing. Univariate and multivariable statistical tests were utilized. A retrospective cohort study of all women diagnosed with gestational diabetes mellitus (GDM) who delivered at our institution 2002-2009 was conducted. Primary outcome was obtaining postpartum (PP) diabetes testing. The group was dichotomized into one cohort that delivered 2002-2007 and the other that delivered 2007-2009. Prior to 2007, GDMs were advised to obtain PP diabetes testing by their PP providers. In 2007, all women received a counseling session at their 37-38 week visit: a registered nurse supplied patients with written and verbal information about PP glucose testing. Univariate and multivariable statistical tests were utilized. ResultsThe overall PP diabetes testing frequency for women delivering after counseling was instituted was 53%, compared to 33% for women delivering prior to the implementation of counseling (p<0.001). When examined by race/ethnicity, Whites (28 to 53%, p<0.001), Latinas (15 to 50%, p<0.001), and Asians (43 to 59%, p=0.005) had increased PP diabetes testing. However, there was a nonsignificant decrease in African-American follow-up, 28% to 17% (p=0.414). Within the 2007-2009 cohort, positive predictors for follow-up included maternal age 35 and insulin use. The sole negative predictor was preterm delivery (Table).Tabled 1Predictors of increased postpartum diabetes testingCharacteristicaOR95%CICounseling Intervention2.061.49-2.86White1.00—African-American0.670.34-1.31Latina0.690.41-1.16Asian1.721.21-2.43Age ≥351.190.87-1.62Insulin Use2.131.54-2.95Preterm Birth0.800.68-0.94 Open table in a new tab The overall PP diabetes testing frequency for women delivering after counseling was instituted was 53%, compared to 33% for women delivering prior to the implementation of counseling (p<0.001). When examined by race/ethnicity, Whites (28 to 53%, p<0.001), Latinas (15 to 50%, p<0.001), and Asians (43 to 59%, p=0.005) had increased PP diabetes testing. However, there was a nonsignificant decrease in African-American follow-up, 28% to 17% (p=0.414). Within the 2007-2009 cohort, positive predictors for follow-up included maternal age 35 and insulin use. The sole negative predictor was preterm delivery (Table). ConclusionGDM often precedes the onset of type 2 diabetes. We have demonstrated that a simple, one-on-one counseling session with patients conducted several weeks prior to delivery increases the follow-up diabetes testing rate. Further efforts are needed to obtain universal testing in these women. GDM often precedes the onset of type 2 diabetes. We have demonstrated that a simple, one-on-one counseling session with patients conducted several weeks prior to delivery increases the follow-up diabetes testing rate. Further efforts are needed to obtain universal testing in these women.