Quality Improvement Project - Increasing Awareness About the Risk of Type 2 Diabetes in Patients with Gestational Diabetes

1. At least 80% of women with gestational diabetes (GDM) seen at our endocrinology clinic will complete screening tests for persistent hyperglycemia 6 to 12 weeks following delivery, during the 8-week project duration.
2. Screening tests are completed in women, not previously tested with recent history of GDM 3 to 6 months post-delivery.
3. Participants will receive diabetes education to increase awareness and promote diabetes prevention measures.

The project identified 25 women seen for medication management for GDM at endocrinology clinic. The subjects were contacted via email and phone by diabetes educator to educate them about the risk of diabetes and the need to comply with post-partum screening for persistent hyperglycemia. 2-hour oral glucose tolerance test (OGTT) or HbA1c were the screening tests used between 6 weeks and 6 months post-delivery. If HbA1c was tested, HbA1c was re-tested 3 months after the initial test. The descriptive data was documented and managed in Excel. The data thus obtained through chart review and follow-up calls helped determine the high-risk patients and promote diabetes prevention.

Results:

A descriptive statistical analysis of data collected proved the effectiveness of the project. During chart review, 7 out of 25 participants (28%) had initially completed HbA1c/ 2h OGTT testing. The project implementation via outreach and diabetes prevention education resulted in screening 10 additional patients. The interventions increased HbA1c testing by 12% with a total of 17 out of 25 participants (68%) having completed testing. While the project objective was to have 80% of women complete testing, the increase in HbA1c testing by 12% underscores the impact of education in increasing awareness about the risk of diabetes. Notably, 36% of women were diagnosed with prediabetes post-partum.

Discussion/Conclusion:

Women with a history of GDM are at increased risk of developing type 2 diabetes. Decreased post-partum patient compliance with testing, attributable to the ongoing pandemic was a limitation of this project. Due to patients’ inability to comply with OGTT during the pandemic, we modified our testing protocol to include HbA1c at 6-12 weeks post-partum and HbA1c 3 months from the initial test to capture trend. 68% of women with GDM completed post-partum screening for hyperglycemia. Awareness of the risk of diabetes increased by 40%. 36% of women who were diagnosed with prediabetes, will benefit from a comprehensive diabetes prevention program.