A-316 Suboptimal Compliance to Postpartum Glucose Monitoring in a High-risk Pregnancy Population - A Single Center Study

Abstract

Abstract Background Gestational diabetes mellitus (GDM) is a predictive factor in developing type 2 diabetes mellitus (T2DM) in affected mothers and their offspring. Its prevalence is increasing proportionally with the obesity epidemic, affecting 10% of pregnant women and 50% of which are likely to develop T2DM. Current guidelines by the American Diabetes Association and the American College of Obstetricians and Gynecologists recommend screening at 4–12 weeks with a 2-hour postpartum glucose tolerance test (OGTT) in patients with a history of GDM. However, several studies have reported suboptimal test ordering and completion rates attributable to the busy postpartum period and provider role confusion between primary care physicians and obstetricians. Due to the complex maternal-fetal cases encountered at our institution, the aim of this study is to evaluate the ordering and test completion rates amongst care providers and patients to ensure compliance with stipulated guidelines. Method We conducted a retrospective audit of women diagnosed with GDM who delivered at our institution from Jan 2019–Oct 2022. We abstracted data from electronic health records. Gestational diabetes was defined by one or more of the following: abnormal 3hr OGTT or 1-hour OGTT of >/=200 mg/dL at >/= 24 weeks. We excluded patients with pre-existing diabetes defined by diagnosis code or by an abnormal 1st trimester 3hr GTT or HbA1C and patients who did not return for a postpartum visit. We compared the proportions of patients with postpartum glucose monitoring orders (glucose tolerance tests or Hemoglobin A1C) to those without orders. Factors such as race, GDM management, provider type and insurance carrier were assessed as potential barriers to non-compliance. Results We identified 356 patients who were diagnosed with GDM during the study period. Of these, 158 patients were excluded who had pre-existing diabetes or did not return for postpartum care. The mean (SD) maternal age was 33.2 (6.0) years. Seventy-four percent (147/198) of patients had a postpartum glucose tolerance test order (Group A), and 26% (51/198) had no laboratory order for glucose monitoring (Group B). The proportion of patients with a completed test order was 24% (35/147), of which four results were abnormal (indicated for diabetes or pre-diabetes). There was no difference in parity, ethnicity, insurance type, diabetes management and provider type between the two groups. Poor compliance was observed in patients with glucose tolerance laboratory orders, while patients with an HbA1c order were 100% compliant. Conclusion Overall, this report demonstrates poor patient compliance with postpartum glucose tolerance testing. Although HbA1C is not recommended for postpartum glucose monitoring, patients were more likely to complete this test.