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Inadequate post-partum screening for type 2 diabetes in women with previous gestation diabetes mellitus: a retrospective audit of practice over 17 years
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  • Rebecca Ward,
  • Anthony Fryer,
  • Fahmy Hanna,
  • Nathaniel Spencer,
  • Madia Mahmood,
  • Pensee Wu,
  • Adrian Heald,
  • Christopher Duff
Rebecca Ward
University Hospitals of North Midlands NHS Trust
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Anthony Fryer
Keele University
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Fahmy Hanna
University Hospitals of North Midlands NHS Trust
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Nathaniel Spencer
University Hospitals of North Midlands NHS Trust
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Madia Mahmood
University Hospitals of North Midlands NHS Trust
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Pensee Wu
Keele University
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Adrian Heald
Salford Royal Hospitals NHS Trust
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Christopher Duff
University Hospitals of North Midlands NHS Trust
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Abstract

Introduction: Women with gestational diabetes (GDM) are at greatly increased risk of type 2 diabetes (T2DM). The UK guidance recommends screening for T2DM at around 6 weeks post-partum and annually thereafter. We evaluated conformity to this guidance in two separate time periods. Methods: The proportion of tests performed within guidance was assessed using longitudinal plasma glucose and glycated haemoglobin data in two cohorts (1999-2007, n=251; 2015-2016, n=260) from hospital records on women previously diagnosed with GDM. Results: In the 1999-2007 and 2015-2016 cohorts, 59.8% and 35.0% of women had the recommended post-partum testing, respectively (p<0.001); just 13.5% and 14.2%, respectively, underwent the first annual test on time. During long-term follow-up of the 1999-2007 cohort (median follow-up: 12.3 years), the proportion of women tested in any given year averaged 34.2% over a 17-year period; there was a progressive decline in the proportion of women receiving a yearly test with time since delivery (p=0.002). Over the follow-up period, 85 women from the 1999-2007 cohort developed blood test results in the diabetic range with a median time to presumed DM diagnosis of 5.2 years (range 0.11-15.95 years). Kaplan-Meier analysis showed that 18.8% of women had blood test results in the diabetes range by 5 years and 37.8% by 10 years post-partum. Conclusions: Despite high profile guidelines and a clear clinical rationale to screen women with a past diagnosis of GDM, many women did not receive adequate screening for T2DM, both in the short- and long-term. This suggests alternative approaches are needed to ensure effective follow-up of this high-risk group. To have an impact, interventions need to be tailored to a young, generally healthy group in which traditional approaches to follow-up may not be best suited.

Peer review status:Published

23 Oct 2020Submitted to International Journal of Clinical Practice
24 Oct 2020Submission Checks Completed
24 Oct 2020Assigned to Editor
10 Nov 2020Reviewer(s) Assigned
01 Feb 2021Review(s) Completed, Editorial Evaluation Pending
03 Mar 20211st Revision Received
03 Mar 2021Submission Checks Completed
03 Mar 2021Assigned to Editor
26 Apr 2021Reviewer(s) Assigned
01 May 2021Review(s) Completed, Editorial Evaluation Pending
11 May 2021Editorial Decision: Accept
09 Jun 2021Published in International Journal of Clinical Practice. 10.1111/ijcp.14447