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Ayala NK, Fain AC, Smith MM, Schlichting LE, Hamel MS, Werner EF. Implementation of In-Hospital Postpartum Glucose Tolerance Testing for People with Gestational Diabetes. Am J Perinatol 2024; 41:969-974. [PMID: 38290557 DOI: 10.1055/a-2257-3341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE We aimed to evaluate uptake of the glucose tolerance test performed during delivery hospitalization as part of routine clinical care. STUDY DESIGN This is a retrospective cohort study of people with GDM at a tertiary center. We collected 9 months of postimplementation data after the in-hospital ("early") glucose tolerance test was adopted as a routine screening option. Adherence was compared between those who elected early glucose tolerance testing versus those who deferred testing to the standard postpartum period. Bivariable statistics including demographics, care team, and postpartum testing/visit attendance were compared between those who received early testing and those who did not using chi-square, Fisher's exact, and t-tests. RESULTS A total of 681 patients with GDM delivered during the study period. Of those who had an early glucose tolerance test ordered (n = 408), 340 (83.3%) completed the test. Among those who did not complete an early glucose tolerance test (ordered and not completed or never ordered), only 104/341 (30.5%) completed any postpartum glucose testing in the first 12 months of postpartum. There were significant differences in characteristics in terms of race/ethnicity, insurance, type of gestational diabetes (A1GDM vs. A2GDM), diabetes medications, obstetric care provider, and delivery mode. Among those who completed early testing, 43.7% of participants had impaired glucose metabolism and 6.5% had values concerning for overt diabetes mellitus. Among those who deferred testing to the standard 6- to 12-week period, 24.0% had impaired glucose metabolism and none had overt diabetes. Those who completed an early glucose tolerance test had a lower rate of postpartum visit attendance compared with those who deferred (75.6 vs. 91.5%, p < 0.01). CONCLUSION In this cohort, when the early glucose tolerance test is offered in clinical practice, adherence rates are higher than when the test is deferred until the postpartum visit. KEY POINTS · Adherence rates with the early glucose tolerance test (GTT) are higher than if the testing is deferred.. · Those who completed an early GTT had a lower rate of postpartum visit attendance compared with those who deferred.. · Offering an in-hospital postpartum GTT can help address low rates of glucose testing postpartum..
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Affiliation(s)
- Nina K Ayala
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Obstetrics and Gynecology, David Geffen School of Medicine UCLA, Los Angeles, California
| | - Audra C Fain
- Department of Obstetrics and Gynecology, David Geffen School of Medicine UCLA, Los Angeles, California
| | - Megan M Smith
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lauren E Schlichting
- Hassenfeld Childe Health and Innovation Institute of Brown University, Providence, Rhode Island
| | - Maureen S Hamel
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Obstetrics and Gynecology, David Geffen School of Medicine UCLA, Los Angeles, California
| | - Erika F Werner
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts
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Tang L, Lebreton E, Vambergue A, Fosse-Edorh S, Olié V, Barry Y, Weill A, Cosson E, Regnault N. Cross-sectional study examining factors impacting on uptake of postpartum type 2 diabetes screening among women diagnosed with hyperglycaemia in pregnancy. Diabetes Res Clin Pract 2024; 208:111116. [PMID: 38266823 DOI: 10.1016/j.diabres.2024.111116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 01/26/2024]
Abstract
AIMS Early postpartum glucose screening of women with hyperglycaemia in pregnancy (HIP) can identify women who have the highest risk of developing impaired glucose tolerance and T2DM. This study examines the association between demographics, events during pregnancy, socioeconomic status and postpartum T2DM screening. METHODS Using the French National Health Data System, this cross-sectional study included all deliveries where the mother had HIP in France in 2015, (n = 76,862). The odds ratio (OR) for attending postpartum screening was calculated via multi-level logistic regression. RESULTS T2DM screening uptake at six months postpartum was 42·9% [95 % Confidence Interval: 42·6-43·3]. Several characteristics were associated with lower uptake: living in the most deprived area(OR = 0·78[0·74-0·83]); being < 25 years-old (reference age group 25-29;≤17: 0.53 [0·31-0·90];18-24: 0.73[0·69-0·78]); smoking (0·65[0·62-0·68]); obesity (0·93[0·89-0·97]); caesarean delivery (0·95[0·92-0·99]). Factors associated with higher uptake included primiparity (1·30[1·26-1·34]); having followed the French recommendations for HIP screening (1·24[1·20-1·28]); insulin prescription (1·75[1·69-1·81]) and pre-eclampsia (1·30[1·19-1·42]). p < 0.01 is justified due to sample size. CONCLUSION Improving identification of factors affecting postpartum T2DM screening uptake, such as demographics, socioeconomic context and events during pregnancy, may lead to development of target interventions to aide adherence to screening regime and thereby diagnosis of women with prediabetes or diabetes, for whom secondary and tertiary prevention is crucial.
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Affiliation(s)
- Luveon Tang
- Santé Publique France, French National Public Health Agency, S(t) Maurice, France.
| | - Elodie Lebreton
- Santé Publique France, French National Public Health Agency, S(t) Maurice, France
| | - Anne Vambergue
- Endocrinology, Diabetology, Metabolism and Nutrition Department, Lille University Hospital, European Genomics Institute for Diabetes, University of Lille, France
| | - Sandrine Fosse-Edorh
- Santé Publique France, French National Public Health Agency, S(t) Maurice, France
| | - Valérie Olié
- Santé Publique France, French National Public Health Agency, S(t) Maurice, France
| | - Yaya Barry
- Santé Publique France, French National Public Health Agency, S(t) Maurice, France
| | - Alain Weill
- EPI-PHARE Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), Saint-Denis, France; Paris 13 University, Sorbonne Paris Cité, AP-HP, Avicenne Hospital, Department of Endocrinology, CRNH-IdF, CINFO, Bobigny, France
| | - Emmanuel Cosson
- Paris 13 University, Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRA, France
| | - Nolwenn Regnault
- Santé Publique France, French National Public Health Agency, S(t) Maurice, France
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Parkhi D, Periyathambi N, Ghebremichael-Weldeselassie Y, Patel V, Sukumar N, Siddharthan R, Narlikar L, Saravanan P. Prediction of postpartum prediabetes by machine learning methods in women with gestational diabetes mellitus. iScience 2023; 26:107846. [PMID: 37767000 PMCID: PMC10520542 DOI: 10.1016/j.isci.2023.107846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/27/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Early onset of type 2 diabetes and cardiovascular disease are common complications for women diagnosed with gestational diabetes. Prediabetes refers to a condition in which blood glucose levels are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes. Currently, there is no accurate way of knowing which women with gestational diabetes are likely to develop postpartum prediabetes. This study aims to predict the risk of postpartum prediabetes in women diagnosed with gestational diabetes. Our sparse logistic regression approach selects only two variables - antenatal fasting glucose at OGTT and HbA1c soon after the diagnosis of GDM - as relevant, but gives an area under the receiver operating characteristic curve of 0.72, outperforming all other methods. We envision this to be a practical solution, which coupled with a targeted follow-up of high-risk women, could yield better cardiometabolic outcomes in women with a history of GDM.
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Affiliation(s)
- Durga Parkhi
- Populations, Evidence, and Technologies, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Nishanthi Periyathambi
- Populations, Evidence, and Technologies, Division of Health Sciences, University of Warwick, Coventry, UK
- Department of Diabetes, Endocrinology, and Metabolism, George Eliot Hospital, Nuneaton, UK
| | - Yonas Ghebremichael-Weldeselassie
- Populations, Evidence, and Technologies, Division of Health Sciences, University of Warwick, Coventry, UK
- School of Mathematics and Statistics, The Open University, Milton Keynes, UK
| | - Vinod Patel
- Department of Diabetes, Endocrinology, and Metabolism, George Eliot Hospital, Nuneaton, UK
| | - Nithya Sukumar
- Populations, Evidence, and Technologies, Division of Health Sciences, University of Warwick, Coventry, UK
- Department of Diabetes, Endocrinology, and Metabolism, George Eliot Hospital, Nuneaton, UK
| | - Rahul Siddharthan
- Department of Computational Biology, The Institute of Mathematical Sciences, Chennai, India
| | - Leelavati Narlikar
- Department of Data Science, Indian Institute of Science Education and Research, Pune, India
| | - Ponnusamy Saravanan
- Populations, Evidence, and Technologies, Division of Health Sciences, University of Warwick, Coventry, UK
- Department of Diabetes, Endocrinology, and Metabolism, George Eliot Hospital, Nuneaton, UK
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Huang J, Forde R, Parsons J, Zhao X, Wang J, Liu Y, Forbes A. Interventions to increase the uptake of postpartum diabetes screening among women with previous gestational diabetes: a systematic review and Bayesian network meta-analysis. Am J Obstet Gynecol MFM 2023; 5:101137. [PMID: 37619781 DOI: 10.1016/j.ajogmf.2023.101137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE This study aimed to summarize the current interventions aimed at improving postpartum diabetes screening attendance and to compare their effectiveness. DATA SOURCES Literature searches were conducted in the Web of Science, Embase, Cochrane Library, CINAHL, and PubMed from inception to March 20, 2023. STUDY ELIGIBILITY CRITERIA Quantitative studies involving an intervention to increase postpartum diabetes screening attendance among women with gestational diabetes mellitus were included. METHODS The Joanna Briggs Institute checklists were used for the quality appraisal of the included studies. A Bayesian network meta-analysis was performed to synthesize the comparative effectiveness of the relevant interventions aimed at improving postpartum diabetes screening rates. RESULTS A total of 40 studies were included in this review with pooled data from 17,123 women. Studies included randomized controlled trials (n=11, including 3 US-based studies and 8 non-US-based studies) and nonrandomised studies (n=29, including 13 US-based studies and 16 non-US-based studies). Of the 14 studies that reported screening outcomes, 11 detected early type 2 diabetes at a rate ranging from 2.0% to 23.0%. The types of interventions identified included reminders (eg, postal letters, emails, and phone messages), educational interventions, screening methods and delivery, policy changes, antenatal groups, and multimodal interventions. Based on the network meta-analysis from randomized controlled trials, antenatal group intervention, which refers to antenatal patient education delivered in groups (1 US-based study), had the highest probability to be the most effective intervention (odds ratio, 10; 95% confidence interval, 1.6-77.0), followed by one-to-one educational intervention with written educational materials or counselling (odds ratio, 6.9; 95% confidence interval, 3.6-16.0). The results from nonrandomized studies indicated that flexible screening methods and delivery (2 US-based studies) had the greatest impact on screening uptake (odds ratio, 3.9; 95% confidence interval, 1.8-10.0), followed by educational interventions (1 US-based study and 2 non-US-based studies) with antenatal patient education and written educational materials (odds ratio, 3.4; 95% confidence interval, 1.9-6.3) and antenatal groups (odds ratio, 3.3; 95% confidence interval, 1.7-6.7). CONCLUSION The presented evidence suggests that antenatal patient education delivered in groups and offering more flexible screening methods were associated with the greatest increase in attendance. The multimodal interventions and reminders could still be important if they were more theoretically grounded and were more integrated into the healthcare system.
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Affiliation(s)
- Jing Huang
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes).
| | - Rita Forde
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
| | - Judith Parsons
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
| | - Xiaoyan Zhao
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
| | - Jianying Wang
- Labour room, Northwest Women's and Children's Hospital, Xi'an, China (Mses Wang and Liu)
| | - Yingjie Liu
- Labour room, Northwest Women's and Children's Hospital, Xi'an, China (Mses Wang and Liu)
| | - Angus Forbes
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
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Shivashri C, Hannah W, Deepa M, Ghebremichael-Weldeselassie Y, Anjana RM, Uma R, Mohan V, Saravanan P. Prevalence of prediabetes and type 2 diabetes mellitus in south and southeast Asian women with history of gestational diabetes mellitus: Systematic review and meta-analysis. PLoS One 2022; 17:e0278919. [PMID: 36508451 PMCID: PMC9744276 DOI: 10.1371/journal.pone.0278919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The burden of Gestational Diabetes Mellitus (GDM) is very high in south Asia (SA) and southeast Asia (SEA). Thus, there is a need to understand the prevalence and risk factors for developing prediabetes and type 2 diabetes mellitus (T2DM) postpartum, in this high-risk population. AIM To conduct a systematic review and meta-analysis to estimate the prevalence of prediabetes and T2DM among the women with history of GDM in SA and SEA. METHODS A comprehensive literature search was performed in the following databases: Medline, EMBASE, Web of Knowledge and CINHAL till December 2021. Studies that had reported greater than six weeks of postpartum follow-up were included. The pooled prevalence of diabetes and prediabetes were estimated by random effects meta-analysis model and I2 statistic was used to assess heterogeneity. RESULTS Meta-analysis of 13 studies revealed that the prevalence of prediabetes and T2DM in post-GDM women were 25.9% (95%CI 18.94 to 33.51) and 29.9% (95%CI 17.02 to 44.57) respectively. Women with history of GDM from SA and SEA seem to have higher risk of developing T2DM than women without GDM (RR 13.2, 95%CI 9.52 to 18.29, p<0.001). The subgroup analysis showed a rise in the prevalence of T2DM with increasing duration of follow-up. CONCLUSION The conversion to T2DM and prediabetes is very high among women with history of GDM in SA and SEA. This highlights the need for follow-up of GDM women for early identification of dysglycemia and to plan interventions to prevent/delay the progression to T2DM.
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Affiliation(s)
- Chockalingam Shivashri
- Division of Populations, Evidence, and Technologies of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, Chennai, Tamil Nadu, India
| | - Wesley Hannah
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, Chennai, Tamil Nadu, India
| | - Mohan Deepa
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, Chennai, Tamil Nadu, India
| | - Yonas Ghebremichael-Weldeselassie
- Division of Populations, Evidence, and Technologies of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- School of Mathematics and Statistics, The Open University, Milton Keynes, United Kingdom
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, Chennai, Tamil Nadu, India
| | - Ram Uma
- Seethapathy Clinic & Hospital, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, ICMR Center for Advanced Research on Diabetes, Chennai, Tamil Nadu, India
| | - Ponnusamy Saravanan
- Division of Populations, Evidence, and Technologies of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Department of Diabetes, Endocrinology, and Metabolism, George Eliot Hospital, Nuneaton, United Kingdom
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