Predictors of Postpartum Diabetes Screening in an Urban Population [25J]

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INTRODUCTION:In postpartum screening up to 1/3 of patients with gestational diabetes mellitus (GDM) will have diabetes or impaired glucose tolerance. We sought to determine rates of screening in an urban population of GDM patients and to determine factors associated with screening.METHODS:This was a retrospective chart-review study. Charts from August 2012 to June 2014 were searched for ICD-9 codes for GDM, and all patients at our medical center who were diagnosed with class A1 or A2 GDM were included. Outcomes included ordering or performance of screening including 2-hour oral glucose tolerance test (2H-OGTT) or other screening modality. Chi-square analyses were used for categorical data and multivariate logistic regression was used to compute odds ratios.RESULTS:There were 118 patients identified (55% class A1). 58% were African-American and 52% had medical assistance insurance. 83% attended the postpartum visit. Screening was discussed at 68% of postpartum visits, but a screening test was only ordered at 55% of visits. 77% of these were 2H-OGTTs. 38% of 2H-OGTTs ordered were completed, of which 38% were abnormal. In multivariate analyses, patients with A2 GDM were more likely to be screened (odds ratio [OR] 2.8 [95% CI: 1.1–7.3]). Attendance at resident clinic was significantly associated with performance of the 2H-OGTT (OR 11.7, 95% CI: 1.6–84.8).CONCLUSION:Rates of postpartum screening for GDM patients are low, both because providers are not ordering screening and because patients do not complete the test. Further efforts must be made to improve follow-up for these vulnerable patients.

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