Do postal reminders increase postpartum screening of diabetes mellitus in women with gestational diabetes mellitus? A randomized controlled trial

Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 03/2009; 200(6):634.e1-7. DOI: 10.1016/j.ajog.2009.01.003
Source: PubMed


Women with previous gestational diabetes mellitus rarely receive the recommended 2-hour oral glucose tolerance test (OGTT) after delivery. We sought to determine whether postal reminders to be sent after delivery to a patient, her physician, or both would increase screening rates.
Patients were assigned randomly to 4 groups: reminders sent to both physician and patient, to physician but not patient, or to patient but not physician or no reminders were sent. The primary outcome was the proportion of patients who underwent an OGTT within 1 year after delivery. The secondary outcome was the performance of other postpartum screening tests.
OGTT rates were significantly increased in the physician/patient reminder group (49/81 women; 60.5%), in the patient-only reminder group (42/76 women; 55.3%), and in the physician-only reminder group (16/31 women; 51.6%) compared with the no reminder group (5/35 women; 14.3%; P < .05).
Postpartum reminders greatly increased screening rates for women with gestational diabetes mellitus.

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    • "A RCT from New Zealand showed that patient and/or computer reminders resulted in increased screening rates in general practice (Kenealy et al., 2005). Among mothers having gestational diabetes mellitus, a RCT had shown that postal reminder to patient, physician or both was associated with 3 times increase in screening rate (oral glucose tolerance test within a year of delivery) (Clark et al., 2009). Similarly, letter or phone reminder in Canada resulted in 2 times increase in screening rates within 6 months after delivery (Shea et al., 2011) and a retrospective review from Canada also showed 3 fold increase in odds of being screened due to a reminder checklist (Lega et al., 2012). "
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    ABSTRACT: Introduction: We previously showed that there was high loss to follow up for definitive tests, resulting in low screening yield, during opportunistic screening for diabetes with random blood glucose as the initial screening tool. Aims and Objectives: In this study we examined the effect of mobile reminder on follow up for definitive tests and therefore screening yield. Research Design and Methods: This was a facility-based parallel randomized controlled trial during routine outpatient department hours in a primary health care setting. We offered random blood glucose testing to non-pregnant non-diabetic adults (667 total, 390 consented); eligible outpatients (n=268) were offered definitive tests. We randomized eligible outpatients into intervention (n=133) and control arm (n=135): those in intervention arm received a mobile reminder to follow up for definitive tests. We measured blood glucose using a glucometer. Results: Our data showed that eligible outpatients in intervention arm (85.7%) when compared to control arm (53.3%) had 1.6 times more chance of returning for definitive tests [RR = 1.61, (0.95 CI - 1.35,1.91)]. Screening yield in intervention and control arm was 18.6% and 10.2% respectively. Etiologic fraction was 45.2%.and number needed to screen was 11.9. Conclusion: These findings provide objective evidence that mobile reminders result in significant improvement in follow up and therefore improvement in screening yield. Also, considering the wide prevalent use of mobile phones, and real life resource limited settings in which this study was carried out, mobile reminders during opportunistic screening appears feasible for successful replication in the region.
    Full-text · Article · Aug 2015
    • "Introducing a local campaign with multidisciplinary meetings and mobilizing the general practitioners clearly improved the postpartum screening rates[44]. Several studies also demonstrated that installing an electronic system to trigger postpartum reminders with the use of postal reminders, SMS reminders or phone call reminders, helped to improve postpartum screening rates45464748. Furthermore, the National Gestational Diabetes Register in Australia has shown that postpartum rates increase up to 73% with the implementation of a local register system for women with GDM. "
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    ABSTRACT: Women with a history of gestational diabetes (GDM) have an increased risk for developing type 2 diabetes in the years after the index pregnancy. Some women with GDM already develop glucose intolerance in early postpartum. The best screening strategy for glucose intolerance in early postpartum among women with a history of GDM is still debated. We review the most important risk factors of women with GDM to develop glucose intolerance within one year postpartum. We also discuss the current recommendations for screening in early postpartum and the many challenges to organize postpartum follow up in primary care. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
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    • "Only 37.15% of women with GDM decided to undergo testing in perspective of this research study. In common, postpartum screening is apparently low in other parts of world, unreliable from 14% in usual case to 60% in a randomized controlled study[15]. Hunt and colleagues noticed postpartum screening rates from 23% to 58% on screening with a FPG or a 2-hour 75-g OGTT[16]. The necessity for improving postpartum rates must be one of the top priorities for clinicians and public health policy markers. "

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