Gestational diabetes (GDM) is a strong predictor of type 2 diabetes in women, but far too many women who develop GDM are not receiving the postpartum care needed to help them prevent or delay their progression to type 2 diabetes. An important step to reach women with GDM is to improve public health surveillance, which improves data collection, GDM diagnosis documentation, outreach, patient education, and timely interventions. The multi-state and tribal GDM Collaborative developed quality improvement interventions based on the data gaps and findings.
Interventions to improve healthcare provider's care
In 2013, Utah completed a survey of provider practices similar to the 2010 Ohio survey and noted the following: OUTCOME: First, only about one-third of the providers (33.5%) could correctly identify that Type 2 diabetes risk, after a history of GDM, is >40%. This is similar to Ohio's result of 33.4%. Second, only 19.5% of providers reported testing glucose of women with GDM at postpartum visits "all of the time." This differs significantly from Ohio physicians, with 42.3% reporting testing "all the time." Results from the survey have been used to develop a professional education program and Web-site for providers.
Idaho completed a survey of Certified Diabetes Educators to determine counseling practices and perceived communication barriers between educators and patients, and educators and referring providers. OUTCOME: The results of this survey were used in the development of a Statewide GDM Summit, held in December, 2013 for all GDM providers to develop a plan to address GDM in Idaho
Utah conducted mail outreach to mothers with live births and GDM identified on birth certificate to remind mothers of need for postpartum testing and to educate women about GDM. 863 packets were sent out between 10/1/12 and 2/28/13 (Utah). OUTCOME: Since 2009, more than 5,000 women have received the information packet. Rates of self-reported postpartum blood sugar testing increased by 35%, from a pre-intervention baseline of 35.8% to a post-intervention outcome of 48.5%. Oklahoma is currently replicating the Utah mail outreach intervention to mothers with live births and GDM to improve their postpartum visit rate. Of the 55,000 live births during calendar year 2013, 6.5% were identified as having either GDM or abnormal glucose. All women having had a live birth received a postcard reminding them of the need for a postpartum visit. The project sent a fact sheet in July and August to 8,000 providers as a booster to the outreach effort.
Chickasaw Nation collaborated with Brigham Young Women's Center to conduct focus groups of postpartum women with GDM as to their pre-pregnancy and pregnancy behaviors. The goal of the focus group process was to recruit and interview 40 women. OUTCOME: The recruitment process yielded 38 women and 28 women completed the focus groups (73.7%).
Arkansas developed and implemented a tele-medicine GDM diabetes management course for women in 4 underserved counties. Classes began in January 2013; OUTCOME: From January 2013 through August 2013, 21 classes were held, 49 women enrolled, 50% of women attending were Spanish speaking and 38 completed the tele-medicine classes (77.6%).
North Carolina conducted a pilot project to improve GDM education through an integrated team approach utilizing WIC, OB Care Managers, and GDM clinic staff. The pilot site selected was Henderson County Health Department. OUTCOME: This pilot project implemented an integrated team approach to provide GDM education to seven patients and reported a decreased time interval to achieve glucose control (from 7.3 weeks to 3.8 weeks) and an increase in reports of positive lifestyle changes after motivational interviewing (from 20% to 80%).