Gestational Diabetes: DDZ Study Shows Low Aftercare Numbers for High-Risk Patients
Women with gestational diabetes (GDM) are at increased risk of type 2 diabetes after giving birth. However, only around 40 percent of them use postpartum diabetes screening services.
“People with diabetes require continuous care and support to […] avoid complications,” . This is the current message from the organizers of World Diabetes Day under the banner “Access to Diabetes Care”.1
In principle, access to care in Germany is not the problem, “but there remain obstacles for the cross-sectoral and interdisciplinary provision of care,” explains Professor Michael Roden, director of the Department of Endocrinology and Diabetology at Dusseldorf University Hospital and Scientific Director and Executive Board Member of the German Diabetes Center (DDZ). “Socioeconomic and psychosocial factors also play an important role in the decision to make use of care services. Last but not least, we require more diabetologists and the appropriate specialist departments at major hospitals,” demands Roden.
Prof Andrea Icks, director of the Institute for Health Services Research and Health Economics at the Medical Faculty of Heinrich-Heine University Dusseldorf and the DDZ, has studied this topic with her team: “We identified the percentage of postpartum diabetes screenings in a group of 12,991 women listed in the nationwide GestDiab-Register and diagnosed with gestational diabetes during pregnancy for the study period 2015 and 2017,” explains the expert.2
Uptake Associated with Characteristics of the Mother?
In the sample, 38.2 percent of the women were shown to have participated in postpartum screening. Certain characteristics were found to be significantly associated with participation in postpartum screening: older women in the group and those who used insulin while pregnant were more likely to participate. Women with a migration background, those with a higher body mass index (BMI), smokers, and women with poor fasting glucose levels and HbA1c values were less likely to participate. “More than 60 percent of women with GDM did not make use of screening after giving birth. Women with an unfavorable lifestyle were more frequently represented in the group that did not attend screening. We asked ourselves whether the decision of these women to attend or not to attend aftercare was a well-informed one and we see the need for further healthcare services research,” explains Andrea Icks.
The Reasons for the Low Screening Uptake Remain Unclear
The reasons for the low uptake are varied and may rest not only with the patients but also with the service providers and the health care system. National and international studies suggest that socioeconomic status, e.g., level of education, has a significant influence on overall health-related behavior. In a study of the relationship between social disparity and diabetes, the Robert Koch Institute identified similar findings.3 A lack of coordination between family doctors, diabetologists, and gynecologists may also play a role. "Important factors here are the shortage of young professionals on the one hand and the lack of funding for interdisciplinary care on the other," notes Roden.
“With regard to Germany, all we can say today is that a significant number of GDM patients do not undergo screening,” summarizes Andrea Icks. Whether they make a conscious decision against screening or they are not adequately informed of the risk and the services on offer after giving birth remains unclear. The focus on the newborn child, the new life circumstances, and a lack of time may also contribute to them not attending screening. “Further research focusing on this topic is definitely required,” concludes the expert. As part of a current study, a research network under her leadership is studying patient and system-related reasons for the (non-) uptake of available screening services to derive a suitable healthcare model for the future. 4
2 Original publication:
Linnenkamp U,..., Icks A. Postpartum screening of women with GDM in specialised practices: Data from 12,991 women in the GestDiab register. Diabetic Medicine. 2022;39:e14861.;DOI: https://doi.org/10.1111/dme.14861
3 Soziale Ungleichheit und Diabetes mellitus – Zeitliche Entwicklung bei Erwachsenen in Deutschland, Journal of Health Monitoring 2019 4(2); DOI 10.25646/5980
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The German Diabetes Center (DDZ) serves as the German reference center for diabetes. Its objective is to contribute to the improvement of prevention, early detection, diagnosis and treatment of diabetes mellitus. At the same time, the research center aims at improving the epidemiological data situation in Germany. The DDZ coordinates the multicenter German Diabetes Study and is a point of contact for all players in the health sector. In addition, it prepares scientific information on diabetes mellitus and makes it available to the public. The DDZ is part of the Leibniz Association (Wissenschaftsgemeinschaft Gottfried Wilhelm Leibniz, WGL) and is a partner of the German Center for Diabetes Research (DZD e.V.). www.ddz.de/en
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