Gestational Diabetes: Center of Excellence Documents Processes

Objective:   Document standards of practice for pregnant women with gestational diabetes seen through a tribal health system, develop improved care and data systems policies and practices recommendations, and promote collaboration and innovation among internal and external partners.

Methods:  A tribal health system serving as a center of excellence for gestational diabetes collaborated with a national organization and federal and state diabetes and maternal health programs to validate screening and follow-up care practices

Results: Of the 101 pregnant women, 95.2 % had documented GDM testing, diagnosis, follow-up and education.  Women with abnormal screens were referred to the Comprehensive Diabetes Center for gestational diabetes care from a multi-disciplinary team. Women with multiple risk factors had little documented postpartum follow-up or referrals for overweight or glucose issues. A quality improvement strategy session was convened among the partners with a resultant action plan to be implemented by all partners.

Conclusion: Evidence demonstrates women who have had GDM are 7.4 times more likely to develop type 2 diabetes (DM) than women without.  Strong evidence shows identification, education and long-term follow-up with lifestyle modification can prevent or delay type 2 DM onset.  Our data suggest women with GDM:

• May not receive adequate post-partum education and follow-up and or understand their risk for type 2 diabetes
• May not receive appropriate follow-up postpartum or interventions to minimize conversion to type 2 DM
•  Improved policies, best practices and innovative strategies can be developed to promote and protect the health of women during the child-bearing years.