Boost gestational diabetes screening through QOF, say researchers

Follow-up monitoring in women with gestational diabetes should be added to the QOF to boost 'markedly' poor screening rates, according to researchers.

Follow-up diabetes screening in women with gestational diabetes needs to improve, say researchers (Photo: iStock)
Follow-up diabetes screening in women with gestational diabetes needs to improve, say researchers (Photo: iStock)

Their study found that just one in five women with gestational diabetes receive checks for diabetes after delivery as advised by NICE.

Researchers said the institute's guidelines had not improved screening rates and a different approach was urgently needed amid rising cases of the disease.

Gestational diabetes affects 3.5% of pregnancies in England and Wales, and these patients are at much higher risk of subsequent diabetes.

NICE guidance published in 2008 advises fasting plasma glucose testing at six weeks postpartum to screen for diabetes, followed by annual testing.

Researchers from the University of Surrey looked at data on 473,772 women at 127 GP practices in England, and identified 2,016 cases of gestational diabetes.

Postpartum follow-up within six months was performed in only 18.5% of gestational diabetes cases. In this time, three women developed diabetes and seven had abnormal blood glucose levels.

Even when follow-up did take place, the type of test was recorded in only 35% of cases. Similarly, only a fifth of these women were given longer-term, annual follow-ups.

Researchers said the 2008 NICE guidelines had had little effect on screening rates.

They said women may be lost to follow-up due to confusion between primary and secondary care about who is responsible for screening. This may be due to a lack of communication or the perception that gestational diabetes follow-up is not a clinical priority, they said.

But intervening early in women with pre-diabetes can delay or prevent the onset of diabetes.

They said: ‘The present study shows that substantial improvements in post-gestational diabetes screening rates are required in England, despite the release of national guidelines. Effective ways of improving screening rates are urgently needed in primary care.

‘Strategies to improve long-term follow-up could include compiling a gestational diabetes recall register, setting up computer alerts to facilitate annual recall (then informing females in writing of their need to be screened), and the inclusion of screening in pay-for-performance programme targets (QOF in the UK).’

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