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Diabetes

Poster Session 1

(236) Implementation Study of Early Postpartum Glucose Tolerance Test

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Recent data have shown that inpatient glucose tolerance tests (GTTs) >24 hours after delivery have similar diagnostic utility as the standard of care 4-12 weeks postpartum GTT to identify prediabetes and diabetes after gestational diabetes mellitus (GDM). Given low completion of the 4-12 week postpartum GTT, we sought to assess completion rate of the inpatient postpartum GTT in clinical care.

Study Design: A prospective, single-center implementation study was performed at a tertiary care, urban hospital. Implementation strategy included interdisciplinary clinical protocol development, staff education, electronic health record modifications, and direct patient communication. All admitted postpartum patients with GDM were eligible for enrollment in the study and inpatient GTTs unless they received steroids in the prior 7 days, were critically ill, or could not tolerate a glucose load. The primary outcome assessed was postpartum GTT completion. Individuals who elected inpatient testing were compared to those who deferred testing to 4-12 weeks postpartum.

Results: Between June 2022 and July 2023, 94% (161/171) of patients with GDM receiving postpartum care at our center were eligible for inpatient postpartum GTTs. Following implementation of the inpatient GTT option, 75% (n=120) of eligible postpartum patients elected inpatient testing. Postpartum GTT completion was significantly higher among those who elected inpatient GTTs compared to those who deferred testing (93% v 17%, p< 0.001, Figure). Maternal characteristics did not differ between those who desired inpatient GTTs and those who deferred testing except that those requiring medication management for GDM were more likely to elect inpatient GTTs (p=0.01). Among those whose GTT was deferred, 76% cited personal preference, 5% cited medical recovery needs, and 19% were not offered early testing. Postpartum visit attendance did not differ by timing of the GTT (57% v 59%, p=0.90).

Conclusion: When postpartum GTTs are offered as part of routine inpatient care after GDM, >90% test completion can be achieved with simple implementation strategies.