Bernstein Judith Apt, Quinn Emily, Ameli Omid, Craig Myrita, Heeren Timothy, Lee-Parritz Aviva, Iverson Ronald, Jack Brian, McCloskey Lois
Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA.
Department of Obstetrics, Boston University School of Medicine, Boston, Massachusetts, USA.
BMJ Open Diabetes Res Care. 2017 Sep 7;5(1):e000445. doi: 10.1136/bmjdrc-2017-000445. eCollection 2017.
Gestational diabetes mellitus (GDM) is a known harbinger of future type 2 diabetes mellitus (T2DM), hypertension, and cardiac disease. This population-based study was designed to identify gaps in follow-up care relevant to prevention of T2DM in a continuously insured sample of women diagnosed with GDM.
We analyzed data spanning 2005-2015 from OptumLabs Data Warehouse, a comprehensive, longitudinal, real-world data asset with deidentified lives across claims and clinical information, to describe patterns of preventive care after GDM. Women with GDM were followed, from 1 year preconception through 3 years postdelivery to identify individual and healthcare systems characteristics, and report on GDM-related outcomes: postpartum glucose testing, transition to primary care for monitoring, GDM recurrence, and T2DM onset.
Among 12 622 women with GDM, we found low rates of glucose monitoring in the recommended postpartum period (5.8%), at 1 year (21.8%), and at 3 years (51%). A minority had contact with primary care postdelivery (5.7% at 6 months, 13.2% at 1 year, 40.5% at 3 years). Despite increased population risk (GDM recurrence in 52.2% of repeat pregnancies, T2DM onset within 3 years in 7.6% of the sample), 70.1% of GDM-diagnosed women had neither glucose testing nor a primary care visit at 1 year and 32.7% had neither at 3 years.
We found low rates of glucose testing and transition to primary care in this group of continuously insured women with GDM. Despite continuous insurance coverage, many women with a pregnancy complication that portends risk for future chronic illness fail to obtain follow-up testing and may have difficulty navigating between clinician specialties. Results point to a need for action to close the gap between obstetrics and primary care to ensure receipt of preventive monitoring as recommended by both the American Diabetes Association and the American Congress of Obstetricians and Gynecologists.
妊娠期糖尿病（GDM）是未来2型糖尿病（T2DM）、高血压和心脏病的已知先兆。这项基于人群的研究旨在确定在持续参保的被诊断为GDM的女性样本中，与预防T2DM相关的后续护理方面的差距。
我们分析了OptumLabs数据仓库2005 - 2015年的数据，这是一个全面的、纵向的、真实世界的数据资产，包含去识别化的索赔和临床信息，以描述GDM后的预防护理模式。对患有GDM的女性进行随访，从孕前1年到产后3年，以确定个体和医疗系统特征，并报告与GDM相关的结果：产后血糖检测、转至初级保健进行监测、GDM复发和T2DM发病。
在12622名患有GDM的女性中，我们发现推荐的产后时期（5.8%）、1年时（21.8%）和3年时（51%）的血糖监测率较低。少数人在产后与初级保健有接触（6个月时为5.7%，1年时为13.2%，3年时为40.5%）。尽管人群风险增加（52.2%的再次妊娠中有GDM复发，7.6%的样本在3年内发生T2DM），但70.1%被诊断为GDM的女性在1年时既没有进行血糖检测也没有看初级保健医生，32.7%在3年时也是如此。
我们发现这组持续参保的患有GDM的女性中血糖检测率和转至初级保健的比例较低。尽管有持续的保险覆盖，但许多有妊娠并发症且预示未来患慢性病风险的女性未能接受后续检测，并且在不同临床专科之间转诊可能存在困难。结果表明需要采取行动缩小产科和初级保健之间的差距，以确保按照美国糖尿病协会和美国妇产科医师大会的建议接受预防性监测。
