RT Journal Article
SR Electronic
T1 Missed opportunities for diabetes prevention: post-pregnancy follow-up of women with gestational diabetes mellitus in England
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e611
OP e619
DO 10.3399/bjgp11X601316
VO 61
IS 591
A1 Mary Pierce
A1 Jo Modder
A1 Iman Mortagy
A1 Anna Springett
A1 Heather Hughes
A1 Stephanie Baldeweg
YR 2011
UL http://bjgp.org/content/61/591/e611.abstract
AB Background Women with gestational diabetes mellitus (GDM) should be followed-up to exclude ongoing diabetes and for prevention of type 2 diabetes. The National Institute for Health and Clinical Excellence (NICE) diabetes in pregnancy guideline recommends checking fasting plasma glucose (FPG) at 6 weeks postpartum (short term), and annually thereafter (long term).Aim To examine the reported practice regarding GDM follow-up.Design and setting Nationwide postal survey in England 2008-2009.Method Questionnaires were distributed to a consultant diabetologist and obstetrician in all maternity units, and to a random sample of general practices (approximately 1 in 5).Results Response rates were: 60% (915/1532) GPs, 93% (342/368) specialists; 80% of GPs and 98% of specialists reported women with GDM had short-term follow-up. More GPs (55%) than specialists (13%) used a FPG test to exclude ongoing diabetes; 26% of GPs versus 89% of specialists thought the hospital was responsible for ordering the test. Twenty per cent of GPs had difficulty in discovering women had been diagnosed with GDM in secondary care. Seventy-three per cent of specialists recommended long-term follow-up; only 39% of GPs recalled women with GDM for this. A minority of GPs and specialists had joint follow-up protocolsConclusion Follow-up of GDM in England diverged from national guidance. Despite consensus that short-term follow-up occurred, primary and secondary care doctors disagreed about the tests and responsibility for follow-up. There was lack of long-term follow-up. Agreement about the NICE guideline, its promotion and effective implementation by primary and secondary care, and the systematic recall of women with GDM for long-term follow-up is required.