Gestational diabetes: screening uptake, current challenges and the future – a focused review

Elpida Vounzoulaki, Kamlesh Khunti, Bee K Tan, Melanie J Davies, Clare L Gillies

Abstract


The increased risk of developing type 2 diabetes mellitus (T2DM) in women with a history of previous gestational diabetes mellitus (GDM) has been established and is well recognised. Post-partum screening for T2DM is essential to identify those at higher risk and allow for the implementation of preventative interventions. However, attendance rates for post-partum glucose screening in women with previous GDM remain substantially low, with only half of them attending screening. This review aimed to outline the National Institute for Health and Care Excellence (NICE) post-partum screening recommendations and compare them with the guidelines being used worldwide, provide information on post-partum screening uptake and possible determinants of uptake in the UK, and to briefly discuss both patient health implications and the financial burden associated with T2DM progression in the context of the National Health Service (NHS).


Keywords


gestational diabetes mellitus, type 2 diabetes mellitus, post-partum screening, United Kingdom

Full Text:

PDF HTML

References


American Diabetes Association (ADA). Classification and diagnosis of diabetes: Standards of medical care in diabetes 2019. Diabetes Care. 2019;42(January):S13–28. https://doi.org/10.2337/dc19-S002

International Diabetes Federation. IDF Diabetes Atlas, 9th edn.Brussels, Belgium. 2019. https://www.diabetesatlas.org

The HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcomes. 2008;358(19):1991–2002. https://doi.org/10.1056/NEJMoa0707943

Noctor E. Type 2 diabetes after gestational diabetes: The influence of changing diagnostic criteria. World J Diabetes. 2015;6(2):234-244. https://doi.org/10.4239/wjd.v6.i2.234

Morton S, Kirkwood S, Thangaratinam S. Interventions to modify the progression to type 2 diabetes mellitus in women with gestational diabetes. Curr Opin Obstet Gynecol. 2014;26(6):476–86. https://doi.org/10.1097/gco.0000000000000127

Tovar A, Chasan-Taber L, Eggleston E, Oken E. Postpartum screening for diabetes among women with a history of gestational diabetes mellitus. Prev Chronic Dis. 2011;8(6):A124. http://www.cdc.gov/pcd/issues/2011/nov/11_0031.htm

The National Institute for Health and Care Excellence (NICE). Diabetes in pregnancy: management from preconception to the postnatal period. Feb 2015. https://www.nice.org.uk/guidance/ng3

The American College of Obstetricians, and Gynecologists (ACOG). Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018;131(2). 10.1097/AOG.0000000000002501

American Diabetes Association (ADA). Management of diabetes in pregnancy: Standards of medical care in diabetes 2019. Diabetes Care. 2019;42(January):S165–72. https://doi.org/10.2337/dc19-S014

Metzger BE, Buchanan TA, Coustan DR, et al. Summary and Recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care . 2007;30(Supplement 2). https://doi.org/10.2337/dc07-s225

Feig DS, Berger H, Donovan L. 2018 Clinical Practice Guidelines. Diabetes and Pregnancy. Diabetes Canada Clinical Practice Guidelines Expert Committee. Can J Diabetes. 2018;42:255–82.

Royal Australian College of General Practitioners. General practice management of type 2 diabetes. Diabetes Australia. 2016.

Nankervis A, McIntyre HD, Moses R, et al. ADIPS Consensus Guidelines for the Testing and Diagnosis of Hyperglycaemia in Pregnancy in Australia and New Zealand. 2014;(November):1–8.

Meijnikman AS, De Block CEM, Dirinck E, et al. Not performing an OGTT results in significant underdiagnosis of (pre)diabetes in a high risk adult Caucasian population. Int J Obes . 2017;41(11):1615–20. http://dx.doi.org/10.1038/ijo.2017.165

Kousta E, Lawrence NJ, Penny A, et al. Implications of new diagnostic criteria for abnormal glucose homeostasis in women with previous gestational diabetes. Diabetes Care. 1999;22(6):933–7. https://doi.org/10.2337/diacare.22.6.933.

Kim C, Herman WH, Cheung NW, Gunderson EP, Richardson C. Comparison of hemoglobin A 1c with fasting plasma glucose and 2-h postchallenge glucose for risk stratification among women with recent gestational diabetes mellitus. Diabetes Care. 2011;34(9):1949–51. https://doi.org/10.2337/dc11-0269

Sanderson H, Loveman E, Colquitt J, Royle P, Waugh N, Tan B. Improving Uptake of Postnatal Checking of Blood Glucose in Women Who Had Gestational Diabetes Mellitus in Universal Healthcare Settings: A Systematic Review. J Clin Med. 2018;8(1):4. http://dx.doi.org/10.3390/jcm8010004

Van Ryswyk E, Middleton P, Shute E, Hague W, Crowther C. Women’s views and knowledge regarding healthcare seeking for gestational diabetes in the postpartum period: A systematic review of qualitative/survey studies. Diabetes Res Clin Pract. 2015;110(2):109–22. https://doi.org/10.1016/j.diabres.2015.09.010

Eborall H, Stone M, Aujla N, Taub N, Khunti K, Davies M. Influences on the uptake of diabetes screening: A qualitative study in primary care. Br J Gen Pract. 2012;62(596):204–11. http://dx.doi.org/10.3399/bjgp12X630106

Noctor E, Crowe C, Carmody LA, et al. ATLANTIC DIP: Simplifying the follow-up of women with previous gestational diabetes. Eur J Endocrinol. 2013;169(5):681–7. http://dx.doi.org/10.1530/EJE-13-0491

The International Expert Committee. Report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32(7):1327–34. http://dx.doi.org/10.2337/dc09-9033

Mostafa SA, Davies MJ, Srinivasan BT, Carey ME, Webb D, Khunti K. Should glycated haemoglobin (HbA1c) be used to detect people with type 2 diabetes mellitus and impaired glucose regulation? Postgrad Med J. 2010;86(1021):656–62. http://dx.doi.org/10.1136/pgmj.2009.091215

Li-Zhen L, Yun X, Xiao-Dong Z, et al. Evaluation of guidelines on the screening and diagnosis of gestational diabetes mellitus: Systematic review. BMJ Open. 2019;9(5):1–10. http://dx.doi.org/10.1136/bmjopen-2018-023014

Nielsen KK, Kapur A, Damm P, de Courten M, Bygbjerg IC. From screening to postpartum follow-up - the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review. BMC Pregnancy Childbirth. 2014;14(1). http://dx.doi.org/10.1186/1471-2393-14-41

Pierce M, Modder J, Mortagy I, Springett A, Hughes H. Missed opportunities for diabetes prevention: 2011;(October):611–9. https://doi.org/10.3399/bjgp11X601316

Mcgovern A, Butler L, Jones S, et al. Diabetes screening after gestational diabetes in England : Br J Gen Pract. 2014;(January):17–23. https://doi.org/10.3399/bjgp14X676410

Fahami R, Dhalwani N, Khunti K, Davies M, Seidu S. Postpartum monitoring of women with a history of gestational diabetes — A cross-sectional study of an inner-city population. Prim Care Diabetes. 2019;13(4):376–9. https://doi.org/10.1016/j.pcd.2018.11.010

Walsh S, Htun H, Hodgett S, Barton D. A comparison of follow-up rates of women with gestational diabetes before and after the updated National Institute for Health and Care Excellence guidance advocating routine follow-up, and the association with neighbourhood deprivation. Br J Diabetes. 2019;19:14–8. https://doi.org/10.15277/bjd.2019.202

Carmody L, Egan AM, Dunne FP. Postpartum glucose testing for women with gestational diabetes mellitus: Improving regional recall rates. Diabetes Res Clin Pract. 2015;108(3):e38–41. http://dx.doi.org/10.1016/j.diabres.2015.04.005

Curtis L, Burgess C, McCord N, Masding MG. Early postpartum glycaemic assessment in patients with gestational diabetes. Pract Diabetes.2017;34(3):89–91. https://doi.org/10.1002/pdi.2089

Minsart AF, Vander Maelen A, Fontaine V, Kirkpatrick C. Social, medical and self-perceived factors influencing postpartum screening of diabetes after gestational diabetes. J Obstet Gynaecol (Lahore). 2014;34(1):8–12. http://dx.doi.org/10.3109/01443615.2013.826639

Van Ryswyk EM, Middleton PF, Hague WM, Crowther CA. Women’s views on postpartum testing for type 2 diabetes after gestational diabetes: Six month follow-up to the DIAMIND randomised controlled trial. Prim Care Diabetes. 2016;10(2):91–102. https://doi.org/10.1016/j.pcd.2015.07.003

Sterne V, Logan T, Palmer MA. Factors affecting attendance at postpartum diabetes screening in women with gestational diabetes mellitus. Pract Diabetes Int. 2011;28(2):64–9. http://dx.doi.org/10.1002/pdi.1559

Lie MLS, Hayes L, Lewis-Barned NJ, May C, White M, Bell R. Preventing type 2 diabetes after gestational diabetes: Women’s experiences and implications for diabetes prevention interventions. Diabet Med. 2013;30(8):986–93. https://doi.org/10.1111/dme.12206

Plant N, Šumilo D, Chapman R, Webber J, Saravanan P, Nirantharakumar K. Unmet needs of women with GDM: a health needs assessment in Sandwell, West Midlands. J Public Health. 2019;1–9. https://doi.org/10.1093/pubmed/fdz172

Eades CE, Styles M, Leese GP, Cheyne H, Evans JMM. Progression from gestational diabetes to type 2 diabetes in one region of Scotland: An observational follow-up study. BMC Pregnancy Childbirth. 2015;15(1):1–6. http://dx.doi.org/10.1186/s12884-015-0457-8

Daly B, Toulis KA, Thomas N, et al. Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: A population-based cohort study. PLoS Med . 2018;15(1). http://dx.doi.org/10.1371/journal.pmed.1002488

Kousta E, Efstathiadou Z, Lawrence NJ, et al. The impact of ethnicity on glucose regulation and the metabolic syndrome following gestational diabetes. Diabetologia. 2006;49(1):36–40. http://dx.doi.org/10.1007/s00125-005-0058-6

Goueslard K, Cottenet J, Mariet AS, et al. Early cardiovascular events in women with a history of gestational diabetes mellitus. Cardiovasc Diabetol. 2016;15(1):1–7. http://dx.doi.org/10.1186/s12933-016-0338-0

Foghsgaard S, Andreasen C, Vedtofte L, et al. Nonalcoholic fatty liver disease is prevalent in women with prior gestational diabetes mellitus and independently associated with insulin resistance and waist circumference. Diabetes Care. 2017;40(1):109–16. http://dx.doi.org/10.2337/dc16-1017

Dalfrà MG, Nicolucci A, Bisson T, Bonsembiante B, Lapolla A. Quality of life in pregnancy and post-partum: A study in diabetic patients. Qual Life Res. 2012;21(2):291–8. http://dx.doi.org/10.1007/s11136-011-9940-5

Kolu P, Raitanen J, Rissanen P, Luoto R. Health care costs associated with gestational diabetes mellitus among high-risk women - results from a randomised trial. BMC Pregnancy Childbirth. 2012;12. http://dx.doi.org/10.1186/1471-2393-12-71

Stedman M, Lunt M, Livingston M, et al. The costs of drug prescriptions for diabetes in the NHS. Lancet. 2019 Jan 19;393(10168):226-227. http://dx.doi.org/10.1016/S0140-6736(18)33190-8

Hex N, Bartlett C, Wright D, Taylor M, Varley D. Estimating the current and future costs of Type1 and Type2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabet Med. 2012;29(7):855–62. http://dx.doi.org/10.1111/j.1464-5491.2012.03698.x

Goueslard K, Cottenet J, Mariet AS, Sagot P, Petit JM, Quantin C. Early screening for type 2 diabetes following gestational diabetes mellitus in France: hardly any impact of the 2010 guidelines. Acta Diabetol. 2017;54(7):645–51. http://dx.doi.org/10.1007/s00592-017-0986-x

Kim C, Bahman P, Burke R, et al. Missed Opportunities for Type 2 Diabetes Mellitus Screening Among Women With a History of Gestational Diabetes Mellitus. Am J Public Health. 2006;96(9):1643–8. http://dx.doi.org/10.2105/AJPH.2005.065722

Kwong S, Mitchell RS, Senior PA, Chik CL. Postpartum Diabetes Screening: Adherence rate and the performance of fasting plasma glucose versus oral glucose tolerance test. Diabetes Care. 2009;32(12):2242–4. https://doi.org/10.2337/dc09-0900

Blatt AJ, Nakamoto JM, Kaufman HW. Gaps in diabetes screening during pregnancy and postpartum. Obstet Gynecol. 2011;117(1):61–8. http://dx.doi.org/10.1097/AOG.0b013e3181fe424b

Dennison RA, Fox RA, Ward RJ, Griffin SJ, Usher-Smith JA. Women’s views on screening for Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for increasing uptake. Diabet Med. 2020;37(1):29–43. https://doi.org/10.1111/dme.14081

Peticca P, Shah BR, Shea A, et al. Clinical predictors for diabetes screening in the first year postpartum after gestational diabetes. Obstet Med. 2014;7(3):116–20. http://dx.doi.org/10.1177/1753495X14528487

Benhalima K, Verstraete S, Muylle F, et al. Implementing a Reminder System in the Northern Part of Belgium to Stimulate Postpartum Screening for Glucose Intolerance in Women with Gestational Diabetes: The “Sweet Pregnancy” Project. Int J Endocrinol. 2017. http://dx.doi.org/10.1155/2017/3971914

Halperin IJ, Sehgal P, Lowe J, Hladunewich M, Wong BM. Increasing Timely Postpartum Oral Glucose Tolerance Test Completion in Women with Gestational Diabetes: A Quality-Improvement Initiative. Can J Diabetes. 2015;39(6):451–6. http://dx.doi.org/10.1016/j.jcjd.2015.06.004

Jeppesen C, Kristensen JK, Ovesen P, Maindal HT. The forgotten risk? A systematic review of the effect of reminder systems for postpartum screening for type 2 diabetes in women with previous gestational diabetes. BMC Res Notes. 2015; 26(8):373 https://doi.org/10.1186/s13104-015-1334-2




DOI: https://doi.org/10.15277/bjd.2020.236

Refbacks

  • There are currently no refbacks.


The Journal of the Association of British Clinical Diabetologists