Diabetes Testing Immediately Postpartum After Gestational Diabetes Mellitus: A Randomized Controlled Trial.

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Public Health

Background:

• Postpartum glucose testing after gestational diabetes mellitus (GDM) is often suboptimal.
• Early detection of diabetes post-GDM is crucial for maternal health.
• Current outpatient testing strategies have limitations in completion rates.

Purpose of the Study:

• To compare the effectiveness of inpatient versus outpatient oral glucose tolerance testing (OGTT) for postpartum diabetes screening in women with GDM.
• To evaluate the impact of testing timing on patient satisfaction and diagnosis of prediabetes or type 2 diabetes.

Main Methods:

• A pragmatic, nonblinded randomized controlled trial (RCT) involving 104 participants with GDM.
• Participants were randomized to receive an OGTT either inpatient before discharge or outpatient within 12 weeks postpartum.
• Primary outcome: completion of OGTT by 12 weeks postpartum. Secondary outcomes: patient satisfaction and diabetes diagnosis.

Main Results:

• Inpatient testing resulted in a significantly higher completion rate (92.3%) compared to outpatient testing (26.9%).
• Participants in the inpatient group reported higher satisfaction scores on the Diabetes Treatment Satisfaction Questionnaire (DTSQ).
• A higher proportion of individuals in the inpatient group were diagnosed with prediabetes or type 2 diabetes (50.0% vs 21.4%).

Conclusions:

• Inpatient postpartum glucose testing before delivery discharge substantially increases testing completion rates and patient satisfaction for women with GDM.
• This strategy supports guidelines recommending inpatient testing as an effective option to improve postpartum diabetes screening.
• Implementing inpatient testing can lead to earlier diagnosis and management of diabetes post-GDM.