Gestational Diabetes Postpartum Screening: A Means in Identifying and Preventing the Continuum of Diabetes

Background: According to the CDC, every year 2-10% of pregnancies are affected by gestational diabetes. Groups such as ACOG (American College of Obstetrics & Gynecology) and ADA (American Diabetes Association) recommend assessing for persisting diabetes or prediabetes 4-12 weeks post-partum. It is estimated that 50% of women with GDM will develop diabetes later in life and less than 50% of women complete the recommended postpartum glucose testing (Martinez, Niznik, Yee 2017). GDM often resolves after delivery with up to 33% of women having a continuum of prediabetes or diabetes at their postpartum visit (Killion 2018). Purpose: To develop a sustainable workflow that will increase providers placing orders for two-hour glucose tolerance testing and increase patient completion rate of testing in postpartum patients to evaluate for the progression of type 2 diabetes. Description: The maternal fetal medicine clinic team began working to strengthen workflows focused on patients with GDM when an opportunity was identified in the care of the postpartum patient. Upon further evaluation, a gap was identified in providers placing two-hour GTT orders and patients completing the testing. After completing a baseline gap analysis, our team began utilizing process mapping and report out tools to develop a workflow to increase the completion rate of postpartum screening for diabetes. Evaluation/outcome: Utilizing EMR tools, patient education, and patient reminders to ensure completion of diabetes screening, the maternal fetal medicine clinic was able to increase screening from 26% up to 60%. Early diagnosis and treatment of prediabetes or type 2 diabetes can improve patient outcomes such as having well controlled A1cs and connecting patients to resources for lifestyle changes allowing for earlier interventions and improved patient outcomes.
References 1) Martinez NG, Niznik CM, Yee LM. Optimizing postpartum care for the patient with gestational diabetes mellitus. Am J Obstet Gynecol. 2017 Sep;217(3):314-321. doi: 10.1016/j.ajog.2017.04.033. Epub 2017 Apr 26. PMID: 28455081; PMCID: PMC5581263.
2) American Diabetes Association; 14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2021. Diabetes Care 1 January 2021; 44 (Supplement_1): S200–S210. https://doi.org/10.2337/dc21-S014
3) Killion, Molly M. MS, RN, CNS. Managing Gestational Diabetes Postpartum. MCN, The American Journal of Maternal/Child Nursing: July/August 2018 - Volume 43 - Issue 4 - p 231 doi: 10.1097/NMC.0000000000000444