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\begin{document}

\title{Inadequate post-partum screening for type 2 diabetes in women with
previous gestation diabetes mellitus: a retrospective audit of practice
over 17 years}



\author[1]{Rebecca Ward}%
\author[2]{Anthony Fryer}%
\author[1]{Fahmy Hanna}%
\author[1]{Nathaniel Spencer}%
\author[1]{Madia Mahmood}%
\author[2]{Pensee Wu}%
\author[3]{Adrian Heald}%
\author[1]{Christopher Duff}%
\affil[1]{University Hospitals of North Midlands NHS Trust}%
\affil[2]{Keele University}%
\affil[3]{Salford Royal Hospitals NHS Trust}%


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  \date{May 22, 2024}


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\begin{abstract}
Introduction: Women with gestational diabetes (GDM) are at greatly
increased risk of type 2 diabetes (T2DM). The UK guidance recommends
screening for T2DM at around 6 weeks post-partum and annually
thereafter. We evaluated conformity to this guidance in two separate
time periods. Methods: The proportion of tests performed within guidance
was assessed using longitudinal plasma glucose and glycated haemoglobin
data in two cohorts (1999-2007, n=251; 2015-2016, n=260) from hospital
records on women previously diagnosed with GDM. Results: In the
1999-2007 and 2015-2016 cohorts, 59.8\% and 35.0\% of women had the
recommended post-partum testing, respectively (p\textless{}0.001); just
13.5\% and 14.2\%, respectively, underwent the first annual test on
time. During long-term follow-up of the 1999-2007 cohort (median
follow-up: 12.3 years), the proportion of women tested in any given year
averaged 34.2\% over a 17-year period; there was a progressive decline
in the proportion of women receiving a yearly test with time since
delivery (p=0.002). Over the follow-up period, 85 women from the
1999-2007 cohort developed blood test results in the diabetic range with
a median time to presumed DM diagnosis of 5.2 years (range 0.11-15.95
years). Kaplan-Meier analysis showed that 18.8\% of women had blood test
results in the diabetes range by 5 years and 37.8\% by 10 years
post-partum. Conclusions: Despite high profile guidelines and a clear
clinical rationale to screen women with a past diagnosis of GDM, many
women did not receive adequate screening for T2DM, both in the short-
and long-term. This suggests alternative approaches are needed to ensure
effective follow-up of this high-risk group. To have an impact,
interventions need to be tailored to a young, generally healthy group in
which traditional approaches to follow-up may not be best suited.%
\end{abstract}%



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