Type 2 diabetes screening underperformed in women with gestational diabetes
Less than half of women with gestational diabetes undergo a guideline-recommended test for type 2 diabetes within 12 weeks of delivery, according to a poster unveiled at the virtual 56th EASD Annual Meeting.
The findings are based on a retrospective analysis of data for 650 women (mean age 35 years) who were diagnosed with gestational diabetes between 2016 and 2018.
Giovanni de Gennaro from the University of Pisa reported that just 41% of the women underwent an oral glucose tolerance test for type 2 diabetes between four and 12 weeks after delivery.
Of these, 1.9% had type 2 diabetes and a further 17.5% had impaired glucose tolerance, impaired fasting glucose, or both.
The researchers noted that at the end of 2016, a letter was introduced to recommend postpartum screening to women with gestational diabetes. They found that this letter had a positive impact on uptake, with rates increasing from 32.0% in 2016 to 47.0% in 2017, then dropping slightly to 42.8% in 2018.
Among the women included in the study, 8.3% were of an ethnicity associated with an increased risk for gestational diabetes, 31.1% had prior gestational diabetes, and 33.9% had a first-degree relative with type 2 diabetes. Mean pre-pregnancy BMI among the women was 25.5 kg/m2, with 19.3% classed as obese.
Following a diagnosis of gestational diabetes, the majority (83%) of women were advised to control the condition with diet and physical activity, while the remainder were prescribed insulin.
Further analysis of these baseline characteristics revealed that screening was significantly less likely to occur in women with no family history of type 2 diabetes (38 vs 46%), those younger than 35 years old (33 vs 47%), those with no high school diploma (32% vs 49% with a university degree), and those in unstable employment (35 vs 44%).
After adjustment for potential confounders, just age and education level were independently associated with test adherence. Individuals younger than 35 years were 1.61 times more likely to be non-adherent than older people, while women without a high school diploma were 1.64 times more likely to be non-adherent than those with a higher level of education.
There were no significant associations between test adherence and ethnicity, previous gestational diabetes, prepregnancy BMI, and gestational diabetes treatment.
De Gennaro and co-authors concluded that their results “may help in designing specific strategies to increase the number of women screened after [gestational diabetes].”