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Dunne P, Culliney L, O'Mahony L, Byrne M, Murphy AW, O'Reilly S. Exploring health professionals' knowledge, practices and attitudes regarding gestational diabetes: A cross-sectional Irish national survey. Diabet Med 2024:e15373. [PMID: 38820178 DOI: 10.1111/dme.15373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 06/02/2024]
Abstract
AIM Gestational diabetes confers short- and long-term risk of mother and offspring health complications. Healthcare professionals such as endocrinologists, diabetes nurses, dietitians, midwives and general practitioners provide gestational diabetes care. We sought to explore healthcare professionals' perspectives on gestational diabetes care during pregnancy and postpartum. METHODS Healthcare professionals in the Republic of Ireland, whose role included gestational diabetes care were invited to complete an online 20-item survey between June and September 2022. Social media, professional organisations and personal networks were used for recruitment. Questions included guideline use, postpartum diabetes screening and advice practices. Analyses were performed using SPSS statistical software and free text was coded using NVivo. RESULTS Seventeen healthcare professions across primary and secondary care settings participated (n = 127). No differences were noted between groups (medical, nursing/midwifery, allied health/other); therefore, findings were reported as a single group. Healthcare professionals reported using multiple different guidelines to support gestational diabetes management (n = 14). The most cited were 'Health Service Executive guidelines' (24.5%), 'local guidelines' (13.2%) and National Institute for Clinical Excellence guidelines (11.3%); 12.3% cited uncertainty, and 27.5% reported not to follow any named guidelines. For postpartum follow-up, 39% felt clear guidelines were available to support practice, 37% felt appropriate systems were in place and 29% reported effective communication between primary and secondary care services. Qualitative findings emphasised a desire for improved communication between systems, participants and providers, clear interdisciplinary guidelines, and adequate resourcing for gestational diabetes management and postpartum diabetes prevention, including comprehensive support and follow-up. CONCLUSION System-level challenges and ineffective communication across settings are barriers to optimum postpartum care. Nationally agreed guidelines for best practice gestational diabetes management including postpartum diabetes prevention are needed.
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Affiliation(s)
- Pauline Dunne
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | | | | | - Molly Byrne
- Health Behaviour Change Research Group, University of Galway, Galway, Ireland
| | - Andrew W Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, University of Galway, Galway, Ireland
| | - Sharleen O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
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2
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Huang J, Forde R, Parsons J, Zhao X, Wang J, Liu Y, Forbes A. Interventions to increase the uptake of postpartum diabetes screening among women with previous gestational diabetes: a systematic review and Bayesian network meta-analysis. Am J Obstet Gynecol MFM 2023; 5:101137. [PMID: 37619781 DOI: 10.1016/j.ajogmf.2023.101137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE This study aimed to summarize the current interventions aimed at improving postpartum diabetes screening attendance and to compare their effectiveness. DATA SOURCES Literature searches were conducted in the Web of Science, Embase, Cochrane Library, CINAHL, and PubMed from inception to March 20, 2023. STUDY ELIGIBILITY CRITERIA Quantitative studies involving an intervention to increase postpartum diabetes screening attendance among women with gestational diabetes mellitus were included. METHODS The Joanna Briggs Institute checklists were used for the quality appraisal of the included studies. A Bayesian network meta-analysis was performed to synthesize the comparative effectiveness of the relevant interventions aimed at improving postpartum diabetes screening rates. RESULTS A total of 40 studies were included in this review with pooled data from 17,123 women. Studies included randomized controlled trials (n=11, including 3 US-based studies and 8 non-US-based studies) and nonrandomised studies (n=29, including 13 US-based studies and 16 non-US-based studies). Of the 14 studies that reported screening outcomes, 11 detected early type 2 diabetes at a rate ranging from 2.0% to 23.0%. The types of interventions identified included reminders (eg, postal letters, emails, and phone messages), educational interventions, screening methods and delivery, policy changes, antenatal groups, and multimodal interventions. Based on the network meta-analysis from randomized controlled trials, antenatal group intervention, which refers to antenatal patient education delivered in groups (1 US-based study), had the highest probability to be the most effective intervention (odds ratio, 10; 95% confidence interval, 1.6-77.0), followed by one-to-one educational intervention with written educational materials or counselling (odds ratio, 6.9; 95% confidence interval, 3.6-16.0). The results from nonrandomized studies indicated that flexible screening methods and delivery (2 US-based studies) had the greatest impact on screening uptake (odds ratio, 3.9; 95% confidence interval, 1.8-10.0), followed by educational interventions (1 US-based study and 2 non-US-based studies) with antenatal patient education and written educational materials (odds ratio, 3.4; 95% confidence interval, 1.9-6.3) and antenatal groups (odds ratio, 3.3; 95% confidence interval, 1.7-6.7). CONCLUSION The presented evidence suggests that antenatal patient education delivered in groups and offering more flexible screening methods were associated with the greatest increase in attendance. The multimodal interventions and reminders could still be important if they were more theoretically grounded and were more integrated into the healthcare system.
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Affiliation(s)
- Jing Huang
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes).
| | - Rita Forde
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
| | - Judith Parsons
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
| | - Xiaoyan Zhao
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
| | - Jianying Wang
- Labour room, Northwest Women's and Children's Hospital, Xi'an, China (Mses Wang and Liu)
| | - Yingjie Liu
- Labour room, Northwest Women's and Children's Hospital, Xi'an, China (Mses Wang and Liu)
| | - Angus Forbes
- Division of Care for Long-term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom (Ms Huang, Drs Forde and Parsons, Ms Zhao, and Dr Forbes)
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3
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Marschner S, Pant A, Henry A, Maple‐Brown LJ, Moran L, Cheung NW, Chow CK, Zaman S. Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review. Med J Aust 2023; 218:484-491. [PMID: 37149790 PMCID: PMC10953444 DOI: 10.5694/mja2.51932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 05/08/2023]
Affiliation(s)
| | - Anushriya Pant
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
| | - Amanda Henry
- University of New South WalesSydneyNSW
- St George HospitalSydneyNSW
| | - Louise J Maple‐Brown
- Diabetes across the Lifecourse: Northern Australia Partnership, Menzies School of Health ResearchDarwinNT
- Royal Darwin HospitalDarwinNT
| | - Lisa Moran
- Monash Centre for Health Research and ImplementationMonash UniversityMelbourneVIC
- Monash HealthMelbourneVIC
| | - N Wah Cheung
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Clara K Chow
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
| | - Sarah Zaman
- Westmead Applied Research CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
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4
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O'Reilly SL, May CR, Ford D, Dunbar JA. Implementing primary care diabetes prevention for women with previous gestational diabetes: a mixed-methods study. Fam Pract 2022; 39:1080-1086. [PMID: 35412623 PMCID: PMC9680660 DOI: 10.1093/fampra/cmac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The implementation of diabetes prevention for women with previous gestational diabetes (GDM) has been stymied by many barriers that are located within routine general practice (GP). We aimed to unpack the GP factors and understand the mechanisms that explain why a diabetes prevention intervention for this population succeeds or fails. METHODS We performed a mixed-methods study with a Normalization Process Theory framework that included clinical audits, semistructured interviews, and focus groups within mixed urban and rural primary care practices in Victoria, Australia. Staff of primary care practices and external support staff who provide services to women with previous GDM participated in a 12-month quality improvement collaborative intervention. We compared diabetes screening and prevention activity planning with the strategies and factors identified through a process evaluation of full-, moderate-, and low-active participating practices. RESULTS The intervention doubled screening rates (26%-61%) and 1-in-10 women received a diabetes prevention planning consultation. Critical improvement factors were: mothers being seen as participants in the quality improvement work; staff collectively building care strategies; staff taking a long-term care of a community perspective rather than episodic service delivery; and feedback processes being provided and acted on across the practice. The observable factors from the external perspective were: leadership by identified practice staff, reminder systems in action and practice staff driving the process collectively. CONCLUSIONS Successful engagement in diabetes prevention for women with previous GDM requires proactive building of the critical improvement factors and audit feedback into routine GP.
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Affiliation(s)
- Sharleen L O'Reilly
- School of Exercise and Nutrition Sciences, Institute of Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Carl R May
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dale Ford
- Improvement Foundation, Adelaide, Australia
| | - James A Dunbar
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Australia
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5
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Brown JA, Leonard M, Clinton T, Bower JK, Gillespie SL, Fareed N, Thomas N, Prater L, Lorenz A, May S, Voisin C, Thung S, Oza-Frank R, Bose Brill S. Mothers' Perspectives on a Mother/Infant Dyad Postpartum Primary Care Program Following Gestational Diabetes Mellitus: A Qualitative Pilot Study. Sci Diabetes Self Manag Care 2022; 48:247-257. [PMID: 35658777 DOI: 10.1177/26350106221100539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to characterize mothers' experiences within a mother/infant dyad postpartum primary care program (Dyad) following gestational diabetes mellitus (GDM) to inform improvements in the delivery of care. METHODS A qualitative pilot study of women (n = 10) enrolled in a mother/infant Dyad program was conducted in a primary care practice at a large, urban academic medical center. Respondents were asked a series of open-ended questions about their experience with GDM, the Dyad program, and health behaviors. Interviews were audio-recorded, transcribed verbatim, and analyzed using ground theory with NVivo 12 Plus software. RESULTS Three key themes emerged: (1) Dyad program experience, (2) implementation of health behavior changes, and (3) acknowledgment of future GDM and type 2 diabetes mellitus (T2DM) health risks. Respondents found the Dyad program respondents felt that the program conveniently served mother and infant health care needs in a single appointment. Respondents also valued support from primary care providers when implementing health behavior changes. The Dyad program provided an opportunity for respondents to understand their current and future risk for developing GDM and T2DM. CONCLUSIONS Postpartum women enrolled in the Dyad program received highly personalized primary care services. The results of our study will help integrate patient-centered strategies into models for GDM care to maintain patient engagement in postpartum clinical services.
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Affiliation(s)
- Jordyn A Brown
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio.,Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Melissa Leonard
- Ohio Colleges of Medicine Government Resource Center, Columbus, Ohio
| | - Tiffany Clinton
- Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan
| | - Julie K Bower
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio
| | - Shannon L Gillespie
- The Martha S. Pitzer Center for Women, Children and Youth, The Ohio State College of Nursing, Columbus, Ohio
| | - Naleef Fareed
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Nikki Thomas
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Laura Prater
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio.,Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Allison Lorenz
- Ohio Colleges of Medicine Government Resource Center, Columbus, Ohio
| | - Sara May
- Ohio Colleges of Medicine Government Resource Center, Columbus, Ohio
| | - Christiane Voisin
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Stephen Thung
- Division of General Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Reena Oza-Frank
- Bureau of Maternal, Child and Family Health, Ohio Department of Health, Columbus, Ohio
| | - Seuli Bose Brill
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
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Vounzoulaki E, Khunti K, Miksza JK, Tan BK, Davies MJ, Gillies CL. Screening for type 2 diabetes after a diagnosis of gestational diabetes by ethnicity: A retrospective cohort study. Prim Care Diabetes 2022; 16:445-451. [PMID: 35351389 DOI: 10.1016/j.pcd.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/28/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
AIMS To estimate rates and identify determinants of post-partum glucose screening attendance in women with a history of gestational diabetes mellitus (GDM). METHODS Retrospective cohort study using the Clinical Practice Research Datalink linked to Hospital Episode Statistics, to identify women diagnosed with GDM between 01/01/2000 and 05/11/2018. Age adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression models. RESULTS In 10,868 women with GDM, with an average follow-up of 5.38 years (95% CI 5.31,5.45), there was an average of 3.79 (95% CI 3.70,3.89) screening episodes per individual, with a mean time to first screening test of 1.22 (95% CI 1.18, 1.25) years. South Asian women had a significantly greater likelihood of being screened compared to White women within the first 5 years post-partum, aOR: 1.89 95% CI (1.20,2.98). A low proportion of women received at least one test per year of follow-up (23.87%). Older age at GDM diagnosis, polycystic ovary syndrome, prescribed medication for GDM, and living in England, were all associated with a greater likelihood of being screened. CONCLUSION While the majority of women with previous GDM receive at least one glucose screening test within the first 5 years post-partum, fewer than a quarter of them receive on average one test per year of follow-up. Developing strategies to motivate more women to attend screening in primary care is essential.
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Affiliation(s)
- Elpida Vounzoulaki
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; National Institute for Health Research (NIHR) Applied Research Collaboration, East Midlands (ARC-EM), Leicester Diabetes Centre, Leicester LE5 4PW, UK.
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; National Institute for Health Research (NIHR) Applied Research Collaboration, East Midlands (ARC-EM), Leicester Diabetes Centre, Leicester LE5 4PW, UK
| | - Joanne K Miksza
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Bee K Tan
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK
| | - Melanie J Davies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester LE5 4PW, UK
| | - Clare L Gillies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; National Institute for Health Research (NIHR) Applied Research Collaboration, East Midlands (ARC-EM), Leicester Diabetes Centre, Leicester LE5 4PW, UK
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7
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McLennan NM, Hazlehurst J, Thangaratinam S, Reynolds RM. ENDOCRINOLOGY IN PREGNANCY: Targeting metabolic health promotion to optimise maternal and offspring health. Eur J Endocrinol 2022; 186:R113-R126. [PMID: 35380983 PMCID: PMC9066590 DOI: 10.1530/eje-21-1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/05/2022] [Indexed: 11/16/2022]
Abstract
There is an increase in maternal metabolic burden due to the rise in pregnancies complicated by obesity, gestational diabetes, type 2 diabetes and polycystic ovary syndrome. Metabolic dysfunction during pregnancy is associated with increased risks of long-term morbidity and mortality for women and their offspring. Lifestyle interventions in pregnancy in women at risk of metabolic dysfunction have demonstrated short-term improvements such as reduced gestational weight gain and lowered risk of gestational diabetes. It is not known whether these interventions lead to sustained improvements in the metabolic health of the mother and baby. Pharmacological interventions have also shown benefits for the mother and baby in pregnancy, including improvements in glycaemic control, reduction in gestational weight gain and reduction in large for gestational age infants; however, there remains uncertainty over long-term outcomes for mother and child. Existing studies on interventions targeting metabolic health are limited to selected populations in the preconception and postpartum periods and lack follow-up beyond delivery of the intervention. The COVID-19 pandemic has refocused our attention on the effects of maternal metabolic ill-health that play a role in contributing to premature morbidity and mortality. There is an urgent need for strategies to accurately identify the growing number of women and offspring at risk of long-term adverse metabolic health. Strategies which focus on early identification and risk stratification using individualised risk scores in the pre and inter-conception periods must take priority if we are to target and improve the metabolic health of women and their offspring who are at highest risk.
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Affiliation(s)
- Niamh-Maire McLennan
- MRC Centre for Reproductive Health, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, UK
| | - Jonathan Hazlehurst
- Department of Diabetes and Endocrinology, University Hospital Birmingham Foundation Trust, Birmingham, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women’s and Children’s NHS Trust, Birmingham, UK
| | - Rebecca M Reynolds
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, UK
- Correspondence should be addressed to R M Reynolds;
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8
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Zhong W, Li C, Liu J, Zhou J, Xiao Z, Li C, Wu H. Effect and Significance of High-Quality Nursing on Blood Glucose, Pregnancy Outcome, and Neonatal Complications of Patients with Gestational Diabetes Mellitus. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2426417. [PMID: 35516455 PMCID: PMC9064497 DOI: 10.1155/2022/2426417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the role of high-quality nursing on blood glucose, pregnancy outcome, and neonatal complications in patients with gestational diabetes mellitus. Methods Altogether, 148 patients with GDM admitted to our hospital were selected as the research participants, 83 of whom received high-quality nursing as the observation group (OG). Another 65 patients received only routine care as the control group (CG). The blood sugar level, blood pressure value, and adverse pregnancy outcomes of the OG and the CG of patients after intervention were compared. The changes of psychological state and nursing satisfaction of the OG and the CG of patients were observed. The blood lipid level and neonatal complications of the OG and the CG were detected. Results The blood sugar level of the OG was lower than that of the CG (P < 0.05). The systolic pressure and diastolic pressure of patients in the OG were lower than those in the CG after nursing intervention (P < 0.05). The abnormal delivery rate in the CG was evidently higher than that in the OG (P < 0.05). After intervention, SAS and SDS scores in the OG were lower than those in the CG (P < 0.05). The number of people who needed improvement and were dissatisfied in the OG was evidently lower than that in the CG (P < 0.05). TG and LDL-C in the OG were lower than those in the CG (P < 0.05). The total incidence of complications in the CG was evidently higher than that in the OG (P < 0.05). Conclusion High-quality nursing can reduce blood sugar and blood pressure of GDM patients and has a great protective effect on maternal and infant health, which is worthy of clinical practice.
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Affiliation(s)
- Wenjuan Zhong
- Pediatrics, Wuhan Wuchang Hospital, Wuchang Hospital Affiliated to Wuhan University of Science and Technology, Wuhan 430063, China
| | - Chunxia Li
- Department of Obstetrics and Gynecology, Wuhan Wuchang Hospital, Wuhan 430063, China
| | - Jing Liu
- Nursing Department, Wuhan Wuchang Hospital, Wuhan 430063, China
| | - Jinman Zhou
- Nursing Department, Wuhan Wuchang Hospital, Wuhan 430063, China
| | - Zhong Xiao
- Department of Obstetrics and Gynecology, Wuhan Wuchang Hospital, Wuhan 430063, China
| | - Cuimei Li
- General Surgery, Wuhan Wuchang Hospital, Wuhan 430063, China
| | - Hui Wu
- General Surgery, Wuhan Wuchang Hospital, Wuhan 430063, China
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9
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Women's engagement with diabetes prevention activities and the influence of contact by the Australian national gestational diabetes register. PRACTICAL DIABETES 2021. [DOI: 10.1002/pdi.2336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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10
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Versace VL, Beks H, Wesley H, McNamara K, Hague W, Anjana RM, Mohan V, Khunti K, Dunbar JA. Metformin for Preventing Type 2 Diabetes Mellitus in Women with a Previous Diagnosis of Gestational Diabetes: A Narrative Review. Semin Reprod Med 2021; 38:366-376. [PMID: 33860488 DOI: 10.1055/s-0041-1727203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Women with a history of gestational diabetes mellitus (GDM) are at greater risk of developing type 2 diabetes mellitus (T2DM) when compared with women who have not had GDM. To delay or prevent T2DM, guidelines recommend regular screening in the primary care setting and lifestyle interventions that are largely focused on dietary and physical activity modifications. As the postpartum period can be challenging for women, uptake and engagement in screening and lifestyle interventions have been poor. Poor uptake and engagement places women with a history of GDM at heightened risk for future morbidity and development of T2DM. Metformin has been a longstanding and safe treatment for the control of blood glucose in people with T2DM. Research has supported the efficacy of metformin, used as an adjunct to a lifestyle intervention or as a stand-alone treatment, in preventing T2DM in people at high risk of T2DM. Findings from longitudinal studies have demonstrated the potential for metformin to reduce conversion to T2DM when used by women with a previous diagnosis of GDM. This review examines the potential effectiveness of metformin to reduce the incidence of T2DM among women with a previous diagnosis of GDM in the "real-world" setting.
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Affiliation(s)
| | - Hannah Beks
- School of Medicine, Deakin University, Geelong, Australia
| | - Hannah Wesley
- School of Medicine, Deakin University, Geelong, Australia.,Madras Diabetes Research Foundation, Chennai, India
| | - Kevin McNamara
- School of Medicine, Deakin University, Geelong, Australia
| | - William Hague
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | | | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - James A Dunbar
- School of Medicine, Deakin University, Geelong, Australia
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11
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Lim S, Chen M, Makama M, O'Reilly S. Preventing Type 2 Diabetes in Women with Previous Gestational Diabetes: Reviewing the Implementation Gaps for Health Behavior Change Programs. Semin Reprod Med 2021; 38:377-383. [PMID: 33511581 DOI: 10.1055/s-0040-1722315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gestational diabetes mellitus (GDM) places a woman at high risk of developing subsequent type 2 diabetes mellitus (T2DM), particularly in the first 5 years postpartum. Engaging women in health behavior change during this period is challenging and current diabetes prevention programs were developed for middle-aged adults, all of which have limited the evidence on successful implementation for this high-risk population. In this review, we will first summarize the effects of existing diabetes prevention programs in women with a history of GDM. Second, we suggest that the programs need to be modified according to the facilitators and barriers faced by this population. Third, we propose that improving program penetration, fidelity, and participation is critical for population-level success. Finally, we outline the research priorities to improve the implementation of diabetes prevention programs for postpartum women with a history of GDM.
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Affiliation(s)
- Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Mingling Chen
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Maureen Makama
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Sharleen O'Reilly
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
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12
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MacKay D, Kirkham R, Freeman N, Murtha K, Van Dokkum P, Boyle J, Campbell S, Barzi F, Connors C, O'Dea K, Oats J, Zimmet P, Wenitong M, Sinha A, Hanley AJ, Moore E, Peiris D, McLean A, Davis B, Whitbread C, McIntyre HD, Mein J, McDermott R, Corpus S, Canuto K, Shaw JE, Brown A, Maple-Brown L. Improving systems of care during and after a pregnancy complicated by hyperglycaemia: A protocol for a complex health systems intervention. BMC Health Serv Res 2020; 20:814. [PMID: 32867837 PMCID: PMC7461356 DOI: 10.1186/s12913-020-05680-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/21/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Many women with hyperglycaemia in pregnancy do not receive care during and after pregnancy according to standards recommended in international guidelines. The burden of hyperglycaemia in pregnancy falls disproportionately upon Indigenous peoples worldwide, including Aboriginal and Torres Strait Islander women in Australia. The remote and regional Australian context poses additional barriers to delivering healthcare, including high staff turnover and a socially disadvantaged population with a high prevalence of diabetes. METHODS A complex health systems intervention to improve care for women during and after a pregnancy complicated by hyperglycaemia will be implemented in remote and regional Australia (the Northern Territory and Far North Queensland). The Theoretical Domains Framework was used during formative work with stakeholders to identify intervention components: (1) increasing workforce capacity, skills and knowledge and improving health literacy of health professionals and women; (2) improving access to healthcare through culturally and clinically appropriate pathways; (3) improving information management and communication; (4) enhancing policies and guidelines; (5) embedding use of a clinical register as a quality improvement tool. The intervention will be evaluated utilising the RE-AIM framework at two timepoints: firstly, a qualitative interim evaluation involving interviews with stakeholders (health professionals, champions and project implementers); and subsequently a mixed-methods final evaluation of outcomes and processes: interviews with stakeholders; survey of health professionals; an audit of electronic health records and clinical register; and a review of operational documents. Outcome measures include changes between pre- and post-intervention in: proportion of high risk women receiving recommended glucose screening in early pregnancy; diabetes-related birth outcomes; proportion of women receiving recommended postpartum care including glucose testing; health practitioner confidence in providing care, knowledge and use of relevant guidelines and referral pathways, and perception of care coordination and communication systems; changes to health systems including referral pathways and clinical guidelines. DISCUSSION This study will provide insights into the impact of health systems changes in improving care for women with hyperglycaemia during and after pregnancy in a challenging setting. It will also provide detailed information on process measures in the implementation of such health system changes.
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Affiliation(s)
- D MacKay
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
| | - R Kirkham
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - N Freeman
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - K Murtha
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - P Van Dokkum
- Baker Heart & Diabetes Institute Central Australia, Alice Springs, Australia
| | - J Boyle
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S Campbell
- College of Nursing and Midwifery, Charles Darwin University, Cairns, Australia
| | - F Barzi
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - C Connors
- Top End Health Service, Northern Territory Department of Health, Darwin, Australia
| | - K O'Dea
- Population School of Health Research, University of South Australia, Adelaide, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - J Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - P Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - M Wenitong
- Apunipima Cape York Health Council, Bungalow, Australia
| | - A Sinha
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - A J Hanley
- Department of Nutritional Sciences, Faculty of Medicine and the Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - E Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Australia
| | - D Peiris
- The George Institute for Global Health, Sydney, Australia
| | - A McLean
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - B Davis
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - C Whitbread
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
| | - H D McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - J Mein
- Wuchopperen Health Service, Cairns, Australia
| | - R McDermott
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - S Corpus
- Danila Dilba Health Service, Darwin, Australia
| | - K Canuto
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - J E Shaw
- Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - A Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia
- Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia
| | - L Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
- Royal Darwin Hospital, Darwin, Australia.
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Lorenz A, Oza-Frank R, May S, Conrey EJ, Panchal B, Brill SB, RajanBabu A, Howard K. A quality improvement collaborative increased preventive education and screening rates for women at high-risk for type 2 diabetes mellitus in primary care settings. Prim Care Diabetes 2020; 14:335-342. [PMID: 31706949 DOI: 10.1016/j.pcd.2019.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/19/2019] [Accepted: 09/30/2019] [Indexed: 01/11/2023]
Abstract
AIMS Type 2 diabetes mellitus (T2DM) rates continue to increase across women of reproductive age in the United States. The Ohio Type 2 Diabetes Learning Collaborative aimed to improve education and screening for T2DM among women aged 18-44years at high risk for developing T2DM. METHODS Fifteen primary care practices across Ohio participated in a 12-month quality improvement (QI) collaborative, which included monthly calls to share best practices, one-on-one QI coaching, and Plan-Do-Study-Act cycles. Monthly, practices submitted data on three outcome measures on preventive education and three measures on clinical screening for T2DM. RESULTS Increases across each of the three preventive education rates (range of percent increase: 53.6% - 60.0%) and each of the three screening rates for T2DM (15.0% - 19.4%) were observed. Specifically, screening rates for high-risk women with two or more risk factors for T2DM (excluding gestational diabetes mellitus (GDM)) increased by 16.8% (60.5%-77.3%) while rates for T2DM among women with a history of GDM increased by 15.0% (75.0 - 90.0). CONCLUSIONS A quality improvement collaborative increased preventive education and screening rates for women at high-risk for T2DM in primary care settings.
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Affiliation(s)
- Allison Lorenz
- Ohio Colleges of Medicine Government Resource Center, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States
| | - Reena Oza-Frank
- Ohio Department of Health, 246 N. High Street, Columbus, OH 43215, United States
| | - Sara May
- Ohio Colleges of Medicine Government Resource Center, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States.
| | - Elizabeth J Conrey
- Ohio Department of Health, 246 N. High Street, Columbus, OH 43215, United States
| | - Bethany Panchal
- Ohio State University Rardin Family Practice, The Ohio State University Wexner Medical Center, 2231 N. High St., Columbus, OH 43201, United States
| | - Seuli Bose Brill
- Internal Medicine/Pediatrics at Grandview Yard, The Ohio State University Wexner Medical Center, 895 Yard Street, Columbus, OH 43212, United States
| | - Arun RajanBabu
- Ohio Colleges of Medicine Government Resource Center, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States
| | - Kristin Howard
- Ohio Colleges of Medicine Government Resource Center, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States
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14
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Dennison RA, Fox RA, Ward RJ, Griffin SJ, Usher‐Smith JA. Women's views on screening for Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for increasing uptake. Diabet Med 2020; 37:29-43. [PMID: 31317569 PMCID: PMC6916174 DOI: 10.1111/dme.14081] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2019] [Indexed: 12/16/2022]
Abstract
AIM Many women do not attend recommended glucose testing following a pregnancy affected by gestational diabetes (GDM). We aimed to synthesize the literature regarding the views and experiences of women with a history of GDM on postpartum glucose testing, focusing on barriers and facilitators to attendance. METHODS We systematically identified qualitative studies that examine women's experiences following GDM relating to glucose testing (diabetes screening) or experience of interventions to promote uptake of testing. We conducted a thematic synthesis to develop descriptive and then analytical themes, then developed recommendations to increase uptake based on the findings. We evaluated the quality of each study and the confidence that we had in the recommendations using published checklists. RESULTS We included 16 articles after screening 23 160 citations and 129 full texts. We identified four themes of influences relating to the healthcare system and personal factors that affected both ability and motivation to attend: relationship with health care, logistics of appointments and tests, family-related practicalities and concern about diabetes. We developed 10 recommendations addressing diabetes risk information and education, and changes to healthcare systems to promote increased attendance at screening in this population, most with high or moderate confidence. CONCLUSIONS We have identified a need to improve women's understanding about Type 2 diabetes and GDM, and to adjust healthcare provision during and after pregnancy to decrease barriers and increase motivation for testing. Encouraging higher uptake by incorporating these recommendations into practice will enable earlier management of diabetes and improve long-term outcomes.
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Affiliation(s)
- R. A. Dennison
- Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - R. A. Fox
- School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - R. J. Ward
- Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - S. J. Griffin
- Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - J. A. Usher‐Smith
- Primary Care UnitDepartment of Public Health and Primary CareUniversity of CambridgeCambridgeUK
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