Mercy Hospital St. Louis St. Louis, MO, United States
Objective: Screening for gestational diabetes (GDM) in the postpartum period helps identify a population at risk for diabetes. To achieve greater compliance, it has been proposed that a 2-hour glucose tolerance test be performed inpatient on postpartum day 2. We hypothesize that implementation of this practice in a community hospital will improve postpartum testing compliance rates. The primary outcome is to compare pre-implementation compliance rates to post-implementation compliance rates. Secondary outcomes include determining the percentage of pre-diabetes and diabetes identified, and calculating the anticipated missed patients from previous testing strategies.
Study Design: This is a retrospective cohort study performed after the completion of a quality improvement project. Patients included were diagnosed with GDM and delivered between 10/01/21 and 3/26/2023. The study was powered to detect a 10% or greater improvement rate (alpha =0.05, beta= 80%). The pre-intervention group included 437 patients and the post-intervention group included 203 patients. Data reports were obtained from the EMR and statistical analysis performed.
Results: The pre-intervention group had a compliance rate of 15.3% and the post-intervention group had a compliance rate of 50.3% (p= 0.001). The pre-intervention group diagnosed 9% of women with pre-diabetes and diabetes whereas the post-intervention group diagnosed 26.4% (p= 0.004). Extrapolation of this data reveals that over a 5-year period, 240 patients with abnormal glucose metabolism may be missed utilizing only the previous testing strategy. Non-compliance with inpatient testing was associated with vaginal delivery (p=0.002) and increased gravidity and parity (p= 0.02 and p=0.001).
Conclusion: There was a greater than 300% improvement in compliance after implementation of an inpatient postpartum glucose tolerance test, and 9 times more women were diagnosed with abnormal glucose metabolism. While the compliance rate significantly improved, it is lower than pilot studies. This is likely multifactorial and further research is necessary to discern reasons for non-compliance.
