Screening for gestational diabetes mellitus in primary versus secondary care: The clinical outcomes of a randomised controlled trial. (July 2016)

• Record Type: Journal Article
• Authors: O'Dea, Angela; Tierney, Marie; Danyliv, Andriy; Glynn, Liam G.; McGuire, Brian E.; Carmody, Louise A.; Newell, John; Dunne, Fidelma P.
• Is Part Of: Diabetes research and clinical practice. Volume 117(2016)
• Page Start: 55
• Page End: 63
• Publication Date: 2016-07
• Subjects: APH antepartum haemorrhage -- DIAMOND Diabetes Clinical Management System -- GDM gestational diabetes mellitus -- GP general practitioner -- LGA large for gestational age -- NICU neonatal intensive care unit -- OGTT oral glucose tolerance test -- PET preeclampsia toxemia -- PPH postpartum haemorrhage -- RCT randomised controlled trial; Gestational diabetes mellitus -- GDM -- Screening -- Primary care -- Clinical outcomes; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2016.04.023
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Screening for gestational diabetes must be accessible to the at-risk population. In total 37% of primary carers did not wish to participate in this trial. Primary care may be associated with longer delays to care and higher LGA rates. For continuity of care primary carers should participate in GDM screening and care. Abstract: Aims: To examine the clinical outcomes of screening for gestational diabetes mellitus (GDM) in primary care versus secondary care, in the Irish healthcare system. Design and methods: A parallel group randomised controlled trial (RCT) of screening for GDM in primary versus secondary care was used to examine (i) prevalence, (ii) gestational week of screen, (iii) time to access specialist care, and (iv) maternal and neonatal outcomes. In total 781 women were recruited for screening in primary care ( n = 391) or secondary care ( n = 390). Results: The prevalence of GDM and gestational week of screen were similar in both locations. There was a trend towards a longer time to access diabetes care in primary care (24 days) versus secondary care (19 days), a difference of 5 days ( p = 0.09). Women screened in primary care also showed a trend towards a higher rate of large for gestational age (LGA) infants (20%) than those screened in secondary care (14.7%), ( p = 0.09). There were no differences between groups in maternal outcomes. Conclusions: This RCT suggests that screening for GDM in secondary care may be associated with potentially faster time to access specialist antenatal diabetes care and possibly lower LGA rates. Further research is needed to clarify these findings and to improve the delay in accessing specialist care requires an urgent focus. Further research is needed to test these findings in other health systems.