Compliance with Postpartum Diabetes Screening Recommendations for Patients with Gestational Diabetes

Background: The role of provider type and level of training have not been examined in regard to impact on postpartum testing for patients with gestational diabetes mellitus (GDM). Objective: We sought to determine rates of testing in urban GDM patients and to determine factors associated with diabetes screening compliance, focusing especially on provider type. Methods: Class A1 or A2 GDM patients were identified by chart review. Outcomes included ordering and/or performance of postpartum testing for diabetes mellitus. Chi-squared and multivariate logistic regression analyses were performed. Results: Of the 118 patients identified (55% class A1), 58% were African American, 52% had medical assistance insurance, and 83% attended the postpartum visit. Diabetes testing was discussed at 68% of all postpartum visits, but was only ordered at 55% of visits. The 2-hour glucose tolerance test was ordered at 42 of the 98 (43%) of postpartum visits; however, only 16 tests were completed. Patients seeing resident physicians or midwives were more likely to be tested. Conclusions: Rates of postpartum testing for GDM patients are low. Provider and patient compliance with diabetes screening recommendations are inadequate. Increased education and training of providers and patients may improve screening for diabetes among GDM patients.