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Collaborating to Impact Prevention of Type 2 Diabetes for Women With Gestational Diabetes

Friday, April 10, 2015   (0 Comments)
Posted by: Adeline Yerkes and Joan Ware

Collaborating to Impact Prevention of Type 2 Diabetes for Women With Gestational Diabetes

The Challenge of Gestational Diabetes Today
• Prevalence rates for women with Gestational Diabetes (GDM) are growing due to increased obesity. The rates are estimated to be from 7%-14%, with anticipated growth up to 18%. 
• Currently GDM affects over 240,000 pregnancies annually. 
• Women with GDM have a Relative Risk of 7.4 of developing type 2 diabetes in the next decade. 
• Women with both GDM and Pre-eclampsia are even 18 times more at risk and likely to develop diabetes, hypertension and early heart disease. 
• There are long term adverse health outcomes for both mother and offspring, such as diabetes and early heart disease.
• Only about 50% of women with GDM receive post-partum visits and only about 25% receive post-partum glucose tests to screen for diabetes.
• Studies show type 2 diabetes can be prevented or delayed by long- term follow-up care and risk factor reduction interventions.

The Solution was the development of the Gestational Diabetes Collaborative Better Data Better Care, a multi-state and tribal partnership including CDC, NACDD, 9 states and 4 tribal collaborative partnerships who conducted data driven quality improvement interventions to impact surveillance, clinical systems changes, community linkages and enhance patient, public and professional education.

The Results include the following achievements of the Collaborative Partnerships: 
• All Collaborative Partners conducted a data source inventory and analyzed data with states publishing a GDM Prevalence Report.
• Tribal organizations incorporated GDM into their diabetes registry.
• One state partnership showed 30% increase in GDM reporting on electronic birth certificates by providing a modified maternal worksheet and training for hospital medical records personnel.
• Tribal partnerships assessed electronic medical records utilized in their Women’s Clinics and determined a need to develop GDM templates to capture needed clinical information which enhanced diagnostic and treatment policies to provide and improve care.
• User friendly State Consensus Guidelines and/or GDM Guidelines for screening, diagnosis and follow-up were developed.
• Professional Webinars/video conferencing and web-based professional education were provided
• A telemedicine GDM self-management education program was provided to improve access to patient education and serve non- English speaking women
• Team approach to GDM education and management yields HgAlc below 7% 
• Post-Partum reminders yielded a 35% increase in postpartum visits and glucose screening
• Post-Partum – type 2 diabetes lifestyle prevention education component added to clinical protocol

This initiative's lessons learned create sustainable opportunities for GDM agenda movement by the following these strategies:
• Developing a task force of national partners to focus on addressing the gaps in GDM provider knowledge and practice;
• Assisting state chronic disease programs to recognize that GDM is a pre-diabetes state and women and their offspring are the population with a greater risk for type 2 diabetes;
• Developing innovative technologies that address patient education messaging to improve health literacy about women’s health throughout the life course with special emphasis on GDM and Pre-eclampsia;
• Revisiting the guidance and maternal worksheet for birth certificates as developed by National Center on Health Statistics to improve accuracy of documenting GDM prevalence—suggest adopting the Utah’s guidance and worksheet and
• Assisting epidemiology and statistics departments in partnering with their maternal child health and chronic disease programs for better use of data sources and developing partnerships with external sources.

Involvement is key - Involving all of the players who interact with pregnant women and especially pregnant women with Gestational Diabetes to initiate quality improvement data strategies to improve the data accuracy and being involved in moving the national GDM agenda forward can lead to improved quality and comprehensive care for women with GDM. 

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