Patients Stress Flexibility in Scheduling Diabetes Test After Gestational Diabetes

While gestational diabetes mellitus (GDM) is associated with an 8 times higher lifetime risk of type 2 diabetes (T2D) after pregnancy, recommended screening including glucose abnormality testing uptake often occurs in less than 50% of women.

In a new study, investigators explored opinions of women with a history of GDM on effective recommendations to promote screenings after GDM and determine potential interventions to facilitate screenings.

The team of investigators, led by Rebecca Dennison, PhD, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, observed women in the study wanted to be screened for diabetes after GDM and interventions could include flexibility in appointment location and time.

Study

Investigators noted a total of 556 patients with GDM at the Rosie Hospital between 2014 - 2017 who had a postpartum test within 1 year of delivery

They contacted women with previous GDM to describe the purpose and procedure of the potential interview and ultimately interviewed all participants who were willing to take part.

Eligibility included mothers ≥18 years who had been diagnosed with GDM during any previous pregnancy and were required to be 3 - 48 months postpartum.

Exclusions included women with adverse pregnancy outcomes and those who had participated in a GDM-related pregnancy intervention.

Interviews were considered semi-structured at a time and place of the participant’s choice. They were asked to share their experience with GDM and how they could be supported in a healthy lifestyle.

Then, the participants were asked if they had been screened and why, plans for future screening, and their views on potential interventions to facilitate attendance at both the first postpartum test and annual testing.

In addition, participants were asked about their own ideas and then asked to provide feedback on suggestion cards provided by the investigator.

The team used framework analysis through a review of transcripts and field notes to identify each thematic framework.

Results

A total of 20 participants were interviewed between June 2019 - February 2020.

Investigators noted the median number of pregnancies per participant was 2, with 1 affected by GDM. No participant had been diagnosed with T2D.

Further, 16 participants had undergone a postpartum diabetes test, who determined it was an important part of their care and wanted reassurance they did not have T2D.

Investigators noted they had either been instructed to attend or had the appointment made for them to attend.

However, 3 participants who did not attend testing or who had not been invited did not know it was advised or had forgotten.

In addition, 4 participants were unaware of the recommendation for lifelong testing at the beginning of the interview.

The team discussed 8 themes to support future attendance.

These included understanding GDM and postpartum testing, increasing GP awareness of pregnancy, arranging tests, combining appointments, test location, child-friendly clinics, test used, and stopping self-testing.

They observed that the ability to choose where the test was held was most frequently suggested by the participants.

In addition, they believed changing the processes for arranging tests and combining appointments would help facilitate attendance.

The participants noted that while they wanted to be responsible for their own health, an annual reminder from the GP would be useful to recall the infrequency of the test and combining appointments may ease the burden.

On the other hand, investigators noted the suggestions of child-friendly clinics, more opportunities to understand GDM and role of postpartum testing, stopping self-testing, and increasing their GP’s awareness of their pregnancy received inconsistent feedback from participants.

Some participants believed they already had information on the implications of GDM on future health, while others noted their own unawareness of the need for screening in not undergoing postpartum testing.

Conclusion

The team concluded based on the experiences of participants in the study, future interventions to increase postpartum diabetes screening would consist of multiple processes, including flexible options for women to book their appointment.

“Implementing these changes would require resources that are currently available to other populations being made available to women with GDM, such as reminders to attend annual tests, and investment of clinicians’ time to discuss screening,” investigators wrote.

The study, “Oh, I’ve got an appointment”: A qualitative interview study exploring how to support attendance at diabetes screening after gestational diabetes,” was published online in Diabetic Medicine.