摘要：Objectives. We sought to determine rates and factors associated with screening for type 2 diabetes mellitus (DM) in women with a history of gestational diabetes mellitus. Methods. We retrospectively studied women with diagnosed gestational diabetes mellitus who delivered at a university-affiliated hospital (n=570). Data sources included medical and administrative record review. Main outcome measures were the frequency of any type of glucose testing at least 6 weeks after delivery and the frequency of recommended glucose testing. We assessed demographic data, past medical history, and prenatal and postpartum care characteristics. Results. Rates of glucose testing after delivery were low. Any type of glucose testing was performed at least once after 38% of deliveries, and recommended glucose testing was performed at least once after 23% of deliveries. Among women with at least 1 visit to the health care system after delivery (n=447), 42% received any type of glucose test at least once, and 35% received a recommended glucose test at least once. Factors associated with testing were being married, having a visit with an endocrinologist after delivery, and having more visits after delivery. Conclusions. These findings suggest that most women with gestational diabetes mellitus are not screened for type 2 DM after delivery. Opportunities for DM prevention and early treatment are being missed. Gestational diabetes mellitus (GDM), or glucose intolerance first diagnosed during pregnancy, affects more than 135 000 women each year—between 1% and 14% of all pregnancies. 1 GDM is a major risk factor for the development of maternal type 2 diabetes mellitus (DM) and impaired glucose tolerance (IGT). 2 Therefore, both the American College of Obstetricians and Gynecologists and the American Diabetes Association recommend screening women with a history of GDM for type 2 DM approximately 6 weeks after delivery and periodically thereafter. 3 , 4 Unfortunately, such screening may not occur. One survey of 66 rural patients with a history of GDM showed that 40% of women who delivered in the early 1990s were not tested at all in the 5 years after delivery. 5 For women who were tested, providers initiated testing only about 60% of the time, with the women themselves initiating testing in the remaining instances. No significant difference in DM testing was found between medical specialties. To our knowledge, no other studies in the United States have examined the frequency and predictors of type 2 DM screening in women with a history of GDM. Currently, no national or population-based registries collect information on women with GDM and their follow-up, in part because pregnancy is not a permanent state and because of variable diagnostic criteria for GDM. 3 , 4 Therefore, it is unclear why rates of screening were so low and whether screening rates have improved since the early 1990s. 6 The timely identification of persons at high risk for type 2 DM has taken on new urgency with the publication of the results of the Diabetes Prevention Program. This major clinical trial demonstrated that lifestyle interventions and administration of metformin could delay or prevent the development of type 2 DM in people with prediabetes, or IGT. 7 Currently, persons with IGT are not easily identified, as universal screening for IGT is not recommended. Because screening for GDM is performed almost universally and identifies women at high risk for IGT, 3 , 4 the population with GDM is also an ideal one to screen for IGT. We therefore sought to determine screening rates for type 2 DM and the predictors of screening in a cohort of women with GDM cared for in the University of Michigan Healthcare System, which was previously documented to have excellent quality of care for persons with DM. 8
