Harvard Study Shows Only 1 in 3 With Gestational Diabetes Are Screened for Postpartum DM
Only 37% of eligible women get the postpartum diabetes screening tests recommended by the American Diabetes Association.
Since women with a history of gestational diabetes mellitus (GDM) are at high risk for developing type 2 diabetes (diabetes mellitus, DM) and as the American Diabetes Association recommends regular postpartum diabetes screening for women with a history of GDM, although the American College of Obstetricians and Gynecologists (ACOG) is not as directive, Harvard researchers sought to examine postpartum glycemic testing in women diagnosed with GDM. They conducted an observational cohort study of women diagnosed with GDM at one of two large academic medical centers between 2000 and 2001. Kaplan-Meier estimates of the time from delivery to the first postpartum DM screening tests were determined, and predictors of postpartum DM screening were examined using Cox proportional hazards testing.
They found: “Only 37% of eligible women underwent the postpartum diabetes screening tests recommended by the American Diabetes Association (fasting glucose or oral glucose tolerance test [OGTT]), with a median time from delivery to the first such testing of 428 days. By comparison, 94% of women underwent postpartum cervical cancer screening using a Papanicolaou (Pap) test, with a median time from delivery to Pap testing of 49 days. Even when random glucose testing was included in a broad definition of postpartum DM screening (random or fasting glucose, glycosylated hemoglobin, or OGTT), only two thirds of women (67%) received a postpartum glycemic assessment.”
The researchers concluded: “In the population studied, only 37% of women with a history of GDM were screened for postpartum DM according to guidelines published by the American Diabetes Association. Efforts to improve postpartum DM screening in this high-risk group are warranted. Level of evidence: II-2”
Obstetrics & Gynecology 2005;106:1297-1303. December 1, 2005. Postpartum Diabetes Screening in Women With a History of Gestational Diabetes, Karen V. Smirnakis, MD, PhD, Lisa Chasan-Taber, ScD, Myles Wolf, MD, MMSc, Glenn Markenson, MD, Jeffrey L. Ecker, MD and Ravi Thadhani, MD, MPH
FACT: A1c Is A Predictor of Coronary Disease Even Without Diabetes: It just makes sense that if the A1c is the amount of glucose attached to the red blood cell then the higher the A1c, the sticker your red blood cell is for causing atherosclerosis. Among subjects without diabetes, those with the highest levels of A1C were about 1.5 times more likely to develop CHD than nondiabetic patients with the lowest levels. Each 1% increase in A1C over 4.6% raised the risk of CHD nearly 2.5 times, according to researchers. See This Week’s Item #1 Arch Intern Med 16:1910–1916, 2005.
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