‘Indifference’: letters have no effect on type 2 screening uptake after GDM


‘Diabetes indifference’ may explain why the vast majority of women who have gestational diabetes are failing to act on letters prompting them to attend an annual screen for type 2 diabetes,  Victorian researchers say.

Australia has the world’s first national gestational diabetes register but figures show that high rates of registration are not translating into follow up screening .

Writing in PLOS One, The Mothers after Gestational Diabetes in Australia (MAGDA) group noted that women with previous GDM had a sevenfold increased risk of type 2 diabetes.

One of the purposes of the National Gestational Diabetes Register (NGDR) was to support the follow-up of women for regular diabetes screening and and lifestyle modification to reduce their risk of type 2 diabetes through periodic letters to the GP and the patient, they said.

Data linkage by the authors revealed that 12, 214 mothers were recorded as having had GDM in 2012-13 (SA and VIC combined) on the register.

Rates of registration on the NGDR ranged from 73% in SA (2013) to 91% in VIC (2013) and GDM screening rates were 86% in South Australia and 97% in Victoria.

Figures showed that there was a sharp peak in type 2 diabetes diagnostic testing at 6 weeks postnatally (43% in SA in 2012 and 58% in VIC in 2013). However, the authors said this most likely occurred as part of a regular appointment, corresponding with clinical best practice.

At around 52 weeks and 104 weeks postpartum the data showed a lack of diabetes related blood testing  in women on the register.

“From six weeks after the birth onwards there was no evidence of periodic register mail-outs having any effect whatsoever on encouraging mothers to seek further annual type 2 diabetes follow-up testing,” the researchers said.

They suggested that one explanation for the low uptake was that women who have had GDM do not consider themselves to be at high risk for development of type 2 diabetes.

“Many people do not think diabetes is a serious health problem which may be another reason for lack of annual follow-up … More concrete conditions, like cancer, show higher screening because there is a pathology that people recognise and fear,” they wrote.

Furthermore, diabetes was ‘abstract, asymptomatic, insidious’ and needed a lifelong commitment to prevention and management, they said.

The authors suggested that the NGDR could be used to populate Family Practice-based registers of women who have had GDM as people were more likely to act when the message comes from their family physician.

The National Gestational Diabetes Register (NGDR) is managed by the National Diabetes Support Scheme. Women who meet the criteria for GDM can be registered by their diabetes educator but it is not mandatory.

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