Abstract
Gestational diabetes (GDM) is associated with a high risk of future type 2 diabetes. Despite multiple clinical guidelines highlighting the importance of screening in this high-risk population, many health systems report that fewer than 50 % of eligible women are screened in the postpartum period, and little is known about screening beyond the first postpartum year. Systems-level approaches to screening for and prevention of type 2 diabetes in women with a history of GDM are therefore an opportunity for quality improvement. This review will discuss the literature on interventions to improve screening at the systems level and highlight successful strategies as well as gaps in the existing literature. Future directions for intervention research are suggested.
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DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2010. Prev Chronic Dis. 2014;11:130415.
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and pre-diabetes in the United States, 2011. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf Accessed 18 May 2015.
Shah BR, Retnakaran R, Booth GL. Increased risk of cardiovascular disease in young women following gestational diabetes. Diabetes Care. 2008;31:1668–9.
Feig DS, Zinman B, Wang X, Hux JE. Risk of development of diabetes mellitus after diagnosis of gestational diabetes. CMAJ. 2008;179(3):229–34.
American College of Obstetricians and Gynecologists. Gestational diabetes mellitus. Practice bulletin no. 137. Obstet Gynecol. 2013;122:406–16. This is a summary of the evidence and recommendations directed towards practicing obstetricians and gynecologists and serves as a resource for patient management.
American Diabetes Association. Standards of medical care in diabetes 02914. Diabetes Care. 2014;37:S14–80.
Vandorsten JP, Dodson WC, Espeland MA, Grobman WA, Guise JM, Mercer BM, et al. NIH consensus development conference: diagnosing gestational diabetes mellitus. NIH Consens State Sci Statement. 2013;29(1):1–31.
Smirnakis KV, Chasan-Taber L, Wilf M, Markenson G, Ecker JL, Thadhani R. Postpartum diabetes screening in women with a history of gestational diabetes. Obstet Gynecol. 2005;106(6):1297–303.
Keely E, Clark H, Karovitch K, Graham I. Family physician and patient perspectives on screening for type 2 diabetes following gestational diabetes. Can Fam Physician. 2010;56:558–63.
Gabbe SG, Gregory RP, Power ML, Williams SB, Schulkin J. Management of diabetes mellitus by obstetrician-gynecologists. Obstet Gynecol. 2004;103:1229–34.
Hunt KJ, Conway DL. Who returns for postpartum glucose screening following gestational diabetes mellitus? Am J Obstet Gynecol. 2009;198:404–6.
Dietz PM, Vesco KK, Vallaghan WM, et al. Postpartum screening for diabetes after a gestational diabetes mellitus-affected pregnancy. Obstet Gynecol. 2008;112:868–74. Implementation of standardized algorithms in managed care improved rates of postpartum glucose screen ordering and completion.
Blatt AJ, Nakamoto JM, Kaufman HW. Gaps in diabetes screening during pregnancy and postpartum. Obstet Gynecol. 2011;117:61–8.
Carson MP, Fank MI, Keely E. Original research: postpartum testing rates among women with a history of gestational diabetes—systematic review. Prim Care Diabetes. 2013;7(3):177–86.
Jones EJ, Roche CC, Appel SJ. A review of the health beliefs and lifestyle behaviors of women with previous gestational diabetes. J Obstet Gynecol Neonatal Nurs. 2009;38(5):516–26.
Kim C, McEwen LN, Piette JD, Goewey J, Ferrara A, Walker EA. Risk perception for diabetes among women with histories of gestational diabetes mellitus. Diabetes Care. 2007;30(9):2281–6.
Ferrara A, Peng T, Kim C. Trends in postpartum diabetes screening and subsequent diabetes and impaired fasting glucose among women with histories of gestational diabetes mellitus. Diabetes Care. 2009;32(2):269–74. Implementation of standardized algorithms in managed care improved rates of postpartum glucose screen ordering and completion.
Nicklas JM, Zera CA, Seely EW, Abdul-Rahim ZS, Rudloff ND, Levkoff SE. Identifying postpartum intervention approaches to prevent type 2 diabetes in women with a history of gestational diabetes. BMC Pregnancy Childbirth. 2011;11(23):1–8.
Sterne VL, Logan T, Palmer MA. Factors affecting attendance at postpartum diabetes screening in women with gestational diabetes. Pract Diabetes Int. 2011;28:64–8.
Stuebe A, Ecker J, Bates DW, Zera C, Bentley-Lewis R, Seely E. Barriers to follow-up for women with a history of gestational diabetes. Am J Perinatol. 2010;27:705–10.
Lega IC, McLaughlin H, Coroneos M, Handley-Derry F, Donovan N, Lipscombe LL. A physician reminder to improve postpartum diabetes screening in women with gestational diabetes mellitus. Diabetes Res Clin Pract. 2012;95(3):352–7.
Sasenko M, Liddell J, Cheng YW, Sparks TN, Killion M, Caughey AB. Patient counseling increases postpartum follow-up in women with gestational diabetes mellitus. Am J Obstet Gynecol. 2011;204(522):e1–6.
Clark HD, Graham ID, Karovitch A, Keely EJ. Do postal reminders increase postpartum screening of diabetes mellitus in women with gestational diabetes mellitus in women with gestational diabetes mellitus? A randomized controlled trial. Am J Obstet Gynecol. 2009;634:e1–637. e7.
Shea AK, Shah BR, Clark HD, Malcolm J, Walker M, Karovitch A, et al. The effectiveness of implementing a reminder system into routine clinical practice: does it increase postpartum screening in women with gestational diabetes? Chronic Dis Can. 2011;31(2):58–64.
Arditi C, Rège-Walther M, Wyatt JC, Durieux P, Burnand B. Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2012;Issue 12. Art. No.:CD001175.
Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Of Systematic Reviews 2009;Issue: Art. No.:CD001096.
Zera CA, Bates DW, Stuebe AM, Ecker JL, Seely EW. Diabetes screening reminder for women with prior gestational diabetes: a randomized controlled trial. Obstet Gynecol. 2015;126(1):109–14.
Vesco KK, Dietz PM, Bulkley J, Bruce C, Callaghan WM, England L. A system-based intervention to improve postpartum diabetes screening among women with gestational diabetes. Am J Obstet Gynecol. 2012;207(283):e1–6.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.
Ratner RE, Chrisophi CA, Metzger BE, Dabelea D, Bennett PH, Pi-Sunyer X, et al. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab. 2008;93(12):4774–9.
Ferrara A, Hedderson M, Albright C, Ehrlich SF, Quesenberry CP Jr, Peng T, et al. A pregnancy and postpartum lifestyle intervention in women with gestational diabetes mellitus reduces diabetes risk factors: a feasibility randomized control trial. Diabetes Care 2011.
Nicklas JM, Zera CA, England LJ, Rosner BA, Horton E, Levkoff SE, et al. A web-based lifestyle intervention for women with recent gestational diabetes mellitus: a randomized controlled trial. Obstet Gynecol. 2014;124(3):563–70. A web-based program that integrates some direct contact with a health coach but is largely patient-driven can effectively improve postpartum weight loss.
Reinhardt JA, van der Ploeg HP, Grzegrzulka R, Timperley JG. Implementing lifestyle change through phone-based motivational interviewing in rural-based women with previous gestational diabetes mellitus. Health Promot J Aust. 2012;23(1):5–9.
Shyam S, Arshad F, Ghani RA, Wahab NA, Aafii NS, Nisak MYB, et al. Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: a six months randomized trial. Nutr J. 2013;12:68.
Wein P, Beischer N, Harris C, Permezel M. A trial of simple versus intensified dietary modification for prevention of progression to diabetes mellitus in women with impaired glucose tolerance. Aust N Z J Obstet Gynecol. 1999;39(2):162–6.
Cheung NW, Smith BJ, van der Ploeg HP, Cinnadaio N, Bauman A. A pilot structured behavioural intervention trial to increase physical activity among women with recent gestational diabetes. Diabetes Res Clin Pract. 2011;92(1):e27–9.
Kim C, Draska M, Hess M, Wilson EJ, Richardson CR. A web-based pedometer programme in women with a recent history of gestational diabetes. Diabet Med. 2012;29(20):278–83.
McIntyre H, Peacock A, Miller Y, Koh D, Marshall AL. Pilot study of an individualised early postpartum intervention to increase physical activity in women with previous gestational diabetes. International J Endocrinol 2012;2012:892019-892-19.
Hu G, Tian H, Zhang F, Liu H, Zhang C, Zhang S, et al. Tianjin Gestational Diabetes Mellitus Prevention Program: study design, methods, and 1-year interim report on the feasibility of lifestyle intervention program. Diabetes Res Clin Pract. 2012;98(3):508–17.
Ackermann RT, Duru OK, Albu JB, Schmittdiel JA, Soumerai SB, Wharam JF, et al. Evaluating diabetes health policies using natural experiments. Am J Prev Med. 2015;48(6):747–54.
Schmittdiel JA, Brown SD, Neugebauer R, Adams SR, Adams AS, Wiley D, et al. Health-plan and employer-based wellness programs to reduce diabetes risk: The Kaiser Permanente Northern California NEXT-D Study. Prev Chronic Dis. 2013;10:E15. The NEXT-D study is an example of successful implementation of an integrated coaching and education program supported by a health care organization.
https://clinicaltrials.gov/ct2/show/NCT02147626?term=preeclampsia+cvd+prevention&rank=1. Accessed 8/11/15.
Eggleston EM, Klompas M. Rational use of electronic health records for diabetes population management. Curr Diab Rep. 2014;14:479–89.
Gopalan A, Lorincz IS, Wirtalla C, Marcus SC, Long JA. Awareness of prediabetes and engagement in diabetes risk-reducing behaviors. Am J Prev Med. Jun 2015 (epub ahead of print). People who are aware of their risk are more likely to engage in physical activity and weight loss. This reflects the importance of engaging and empowering at-risk patients.
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Chloe Zera and Christina Yarrington declare that they have no conflict of interest.
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This article is part of the Topical Collection on Health Care Delivery Systems and Implementation in Diabetes
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Yarrington, C., Zera, C. Health Systems Approaches to Diabetes Screening and Prevention in Women with a History of Gestational Diabetes. Curr Diab Rep 15, 114 (2015). https://doi.org/10.1007/s11892-015-0687-1
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DOI: https://doi.org/10.1007/s11892-015-0687-1