Implementation and Evaluation of Immediate in Hospital Postpartum Diabetes Testing after Pregnancies Complicated by Gestational Diabetes

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy, and it is estimated that 70% of pregnant patients diagnosed with GDM annually will develop type 2 diabetes mellitus (T2DM) over their lifetime. Up to one third of affected patients will meet criteria for T2DM or show signs of impaired glucose metabolism at the time of postpartum screening. Despite the importance of postpartum diabetes screening, nearly 40% of patients do not attend a postpartum visit where diabetes screening would be scheduled. Previous research has assessed immediate in-hospital postpartum diabetes screening to improve patient completion of testing, however this has lacked widespread clinical implementation.
Proposed Methods: We aim to perform a mixed method study design to assess the feasibility and success of postpartum implementation of immediate in hospital screening. We will accomplish this via three aims. The first aim will collect qualitative data from both patients with gestational diabetes mellitus and from providers regarding anticipated facilitators and barriers to implementation. We will then implement this screening strategy and the second aim will then collect further qualitative and quantitative data regarding patient and provider experience with this screening approach and assess the number of eligible patients that complete this testing while inpatient. The final aim will assess changes made to clinic care (positive results requiring endocrine consultation or initiation of new medication for diabetes) through retrospective chart review).