Abstract
BackgroundGestational diabetes mellitus (GDM) is an important risk factor for developing type 2 diabetes mellitus (T2DM) later in life. Postpartum screening provides an opportunity for early detection and management of T2DM, but uptake is poor.AimTo explore barriers to screening from clinicians’ perspectives to guide future interventions to increase uptake of postpartum screening.Design and settingSystematic review and qualitative synthesis.MethodQualitative studies included in a previous review were assessed, and then five electronic databases were searched from January 2013 to May 2019 for qualitative studies reporting clinicians’ perspectives on postpartum glucose screening after GDM. Study quality was assessed against the Critical Appraisal Skills Programmes checklist. Qualitative data from the studies were analysed using thematic synthesis.ResultsNine studies were included, containing views from 187 clinicians from both community and hospital care. Three main themes were identified: difficulties in handover between primary and secondary care (ambiguous roles and communication difficulties); short-term focus in clinical consultations (underplaying risk so as not to overwhelm patients and competing priorities); and patient-centric barriers such as time pressures.ConclusionBarriers to diabetes screening were identified at both system and individual levels. At the system level, clarification of responsibility for testing among healthcare professionals and better systems for recall are needed. These could be achieved through registers, improved clinical protocols, and automatic flagging and prompts within electronic medical records. At the individual level, clinicians should be supported to prioritise the importance of screening within consultations and better educational resources made available for women. Making it more convenient for women to attend may also facilitate screening.
Highlights
We identified barriers to diabetes screening at both system and individual levels
The metabolic stress caused by pregnancy can reveal a predisposition to health problems and, gestational diabetes mellitus (GDM) is an important risk factor for the later development of type 2 diabetes mellitus (T2DM)(1)
Hyperglycaemia typically resolves after delivery, women with GDM are approximately eight times more likely to develop T2DM than unaffected women, and a third of women with GDM have been diagnosed with T2DM by 15 years postpartum[4]
Summary
The metabolic stress caused by pregnancy can reveal a predisposition to health problems and, gestational diabetes mellitus (GDM) is an important risk factor for the later development of type 2 diabetes mellitus (T2DM)(1). Hyperglycaemia typically resolves after delivery, women with GDM are approximately eight times more likely to develop T2DM than unaffected women, and a third of women with GDM have been diagnosed with T2DM by 15 years postpartum[4]. Detection of T2DM via screening enables early intervention, which reduces exposure to hyperglycaemia and risks of complications and premature mortality. Gestational diabetes (GDM) is an important risk factor for developing type 2 diabetes (T2DM) later in life. Postpartum screening provides an opportunity for early detection and management of T2DM, but uptake is poor
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