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Poster session II Clinical obstetrics, diabetes, labor, medical-surgical-disease, physiology/endocrinology, prematurity: Abstracts 237 - 386| Volume 208, ISSUE 1, SUPPLEMENT , S118, January 01, 2013

258: Evaluation of the impact of an intensive follow-up program on postpartum glucose tolerance testing

      Objective

      Gestational diabetes mellitus (GDM) is a strong risk factor for developing overt diabetes later in life, and studies have demonstrated that identification of prediabetes can enable interventions preventing subsequent diabetes. Various professional societies have stressed the importance of postpartum glucose tolerance testing (GTT) for patients with GDM, although few strategies have been evaluated. We assessed the impact of a one-year program sponsored by the Rhode Island Department of Health aimed at increasing postpartum GTT using direct nurse and patient navigator supervision.

      Study Design

      During the year of implementation, all GDMs were followed after their delivery. A nurse or bilingual patient navigator contacted patients as often as necessary to encourage attendance at their scheduled 2-hour 75-gram oral GTT and to overcome obstacles to testing including knowledge deficit, language barriers, directions and transportation. Patients with abnormal testing were referred to the appropriate provider. To assess the impact of this strategy, data from all patients with GDM seen in our specialty clinic the previous year served as a control for comparison with data from our intervention group.

      Results

      One hundred seventy five patients treated during the year prior to implementation were compared to 193 in the program. Baseline characteristics were smiliar between in groups (Table). Postpartum GTT increased from 76 (43.4%) to 112 (58%), p=0.01. In the course of the project, compared to the previous year, 7 more cases of impaired fasting glucose were discovered (23 vs 16), along with 6 additional cases of impaired glucose tolerance (18 vs 12) and 4 more cases of overt diabetes (8 vs 4). $1670 dollars were spent per additional postpartum test and $3530 per abnormal test.
      Tabled 1Comparison between participants with prior to and during grant implementation
      Table thumbnail grr19

      Conclusion

      Given that the number needed to treat of prediabetic former GDMs is 5 to prevent or delay one case of diabetes, implementation of direct nurse and outreach worker supervision should be effective with significant long-term benefits.