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Are CCAHS GDM clients being tested 6 weeks postpartum?

Background:

It is recommended that all pregnant women be screened for GDM at 26-28 weeks or prior to this if at a
high risk of having GDM. On the Central Coast GPs are invited to refer diagnosed GDM clients to the
NSCCAHS Gestational Diabetes Ante-Natal Clinic. This clinic consists of a Gestational Diabetes
Getting Started group education session followed by an antenatal clinic individual appointment and
subsequent followup as required.

It is recommended for GDM clients to have a 6 week postpartum OGTT as stated at the initial
education session and as included in written information presented at the education session. The clients
GP provides referral for this test and followup. It is also recommended that GDM clients be tested for
diabetes at least 2 yearly postpartum or more regularly depending on results.

In 2007, 130 GDM mothers were discharged from CCHS hospitals after giving birth. Between May
2007 and April 2008, 139 clients attended the GDM clinic. North Gosford private hospital offers GDM
education for their clients. In Nov 2010, approximately 170 GDM clients were registered with NDSS
from the Central Coast.

Upon registration with NDSS clients are sent an educational brochure ‘Gestational Diabetes – Caring
for yourself and your baby’ and another brochure ‘Life after gestational diabetes’ at 10 months post
registration. At 12 months post registration GDM clients are taken off NDSS registration.

After birth, 2% of GDM will continue to have diabetes and within 10-20 years, 50% of those with
GDM develop Type 2 diabetes (NDSS).


Aim: To establish if CCAHS GDM Clinic clients are having a 6 week postpartum diabetes followup
consisting of an OGTT.

Project: Phone all clients attending GDM clinics within a 3 month period and ask them to answer a
number of scripted questions relating to OGTT after birth of their child. Clients will be contacted 4-5
months postpartum (check baby deaths prior to contact).

Evaluation:
In the nominated 3 month period:
Number of GDM discharged from CCAHS hospitals postpartum.
Number of clients diagnosed with GDM attending gestational diabetes clinic.
Number of diagnosed GDM registered with NDSS.
Number of clients diagnosed with GDM attending GDM clinic who had diabetes followup.




# Diabetes Aust – media release
Version: 8.11.2010
Script                                                            Client’s name /#: ______________________________


Hi / may I speak with / is this _____________ / my name is __________ and I’m calling from the Central Coast Public
Health Unit on behalf of the Gestational Diabetes Group you attended mid last year. I’ve a few questions to see if we can
improve these sessions - about diabetes testing since the birth of their child, do you mind answering them - it will take about
2 minutes? Let me know if you don’t want to answer a question and we’ll move onto the next one.


1. Have you had an oral glucose tolerance test since the birth of your child? Y / N / DK
(Prompt: OGTT- the test that required fasting, a blood sample, drinking a sweet drink & another blood sample after 2 hrs)




If yes:

Who advised you to have this test? It can be more than one: (can be read) Dr / Gest Diabetes Gr / Diabetes Educator / anti-
natal clinic / Diabetes Aust-NDSS / friends / DK / Other: ________________________________________
(prompt: where were you advised to have this; where did you read about this)

When approx. did you have the test?             ________________________________________ / DK

Do you mind telling me your test results?                       Normal / IGT - Pre diabetes / T2D / DK


          (if normal/DK/refuse) When will you have the test again?             ____________________________ / DK
                   ‘Thanks– this testing is important, approximately one in two women who develop gestational diabetes will
          go on to develop T 2 diabetes#. It’s generally recommended you have an oral glucose tolerance test every 2 years or
          more often as directed. And you will need to organize this with your GP….’
                   (If appropriate) Any changes to when will you have the test again? _____________________ / DK
                   ‘If you have any questions about your diabetes testing contact your GP or the Central Coast Diabetes Centre
          on 4320 3321’ TO END


          (if IGT – Prediabetes) Thanks, there will be no more questions. This testing is important, approximately one in two
          women who develop gestational diabetes will go on to develop T 2 diabetes. You’ll be in the care of your GP or
          other health professional. You can also contact the Central Coast Diabetes Centre if you have other questions (4320
          3321). TO END


          (if T2D) Thanks, there will be no more questions. You’ll be in the care of your GP or other health professional. You
          can also contact the Central Coast Diabetes Centre if you have other questions (4320 3321). TO END



                END – ‘Thanks again for your time bye….’




# Diabetes Aust – media release
Version: 8.11.2010
If no/DK:

Do you recall being advised to have an oral glucose tolerance test about 6-8 weeks after having your baby?
Y / N / DK

        If yes: Who advised you to have this test? It can be more than one: (READ) Dr / Gest Diabetes Gr / Diabetes
        Educator / anti-natal clinic / Diabetes Aust-NDSS / friends / DK / Other:
        ________________________________________

        What are the reasons you didn’t have the test? _________________________________________________
        ___________________________________________________________________________________ / DK

        Script? _______________________________________

        (as appropriate)
               Extension: Do you intend to have the test?        Y / N / DK
         OR Extension: When will have the test?           _____________________________________ / DK

        (as appropriate)
        When will you have the test after this?          ________________________________________ / DK TO END

        If no/DK: ‘It is generally recommended that you have an oral glucose tolerance test 6-8 weeks after birth to check if
        your sugar levels have returned to the normal range. And you organize this with your GP’
        Will you have the test in the next 2 months?                                 Y / N / try to / DK
                If no: Why not?          _____________________________________________________

        (as appropriate)
        Will you have a test in the future? Y / N / DK             When?       _____________________ TO END


                END-
                ‘Thanks – this testing is important, approximately one in two women who develop gestational diabetes will go
                on to develop T 2 diabetes#. It’s generally recommended you have an oral glucose tolerance test every 2 years
                or more often as directed. And you will need to organize this with your GP.

                If you have any questions about your diabetes testing contact your GP or the Central Coast Diabetes Centre on
                4320 3321.

                Thanks again for your time bye…’




# Diabetes Aust – media release
Version: 8.11.2010

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Gestational diabetes follow

  • 1. Are CCAHS GDM clients being tested 6 weeks postpartum? Background: It is recommended that all pregnant women be screened for GDM at 26-28 weeks or prior to this if at a high risk of having GDM. On the Central Coast GPs are invited to refer diagnosed GDM clients to the NSCCAHS Gestational Diabetes Ante-Natal Clinic. This clinic consists of a Gestational Diabetes Getting Started group education session followed by an antenatal clinic individual appointment and subsequent followup as required. It is recommended for GDM clients to have a 6 week postpartum OGTT as stated at the initial education session and as included in written information presented at the education session. The clients GP provides referral for this test and followup. It is also recommended that GDM clients be tested for diabetes at least 2 yearly postpartum or more regularly depending on results. In 2007, 130 GDM mothers were discharged from CCHS hospitals after giving birth. Between May 2007 and April 2008, 139 clients attended the GDM clinic. North Gosford private hospital offers GDM education for their clients. In Nov 2010, approximately 170 GDM clients were registered with NDSS from the Central Coast. Upon registration with NDSS clients are sent an educational brochure ‘Gestational Diabetes – Caring for yourself and your baby’ and another brochure ‘Life after gestational diabetes’ at 10 months post registration. At 12 months post registration GDM clients are taken off NDSS registration. After birth, 2% of GDM will continue to have diabetes and within 10-20 years, 50% of those with GDM develop Type 2 diabetes (NDSS). Aim: To establish if CCAHS GDM Clinic clients are having a 6 week postpartum diabetes followup consisting of an OGTT. Project: Phone all clients attending GDM clinics within a 3 month period and ask them to answer a number of scripted questions relating to OGTT after birth of their child. Clients will be contacted 4-5 months postpartum (check baby deaths prior to contact). Evaluation: In the nominated 3 month period: Number of GDM discharged from CCAHS hospitals postpartum. Number of clients diagnosed with GDM attending gestational diabetes clinic. Number of diagnosed GDM registered with NDSS. Number of clients diagnosed with GDM attending GDM clinic who had diabetes followup. # Diabetes Aust – media release Version: 8.11.2010
  • 2. Script Client’s name /#: ______________________________ Hi / may I speak with / is this _____________ / my name is __________ and I’m calling from the Central Coast Public Health Unit on behalf of the Gestational Diabetes Group you attended mid last year. I’ve a few questions to see if we can improve these sessions - about diabetes testing since the birth of their child, do you mind answering them - it will take about 2 minutes? Let me know if you don’t want to answer a question and we’ll move onto the next one. 1. Have you had an oral glucose tolerance test since the birth of your child? Y / N / DK (Prompt: OGTT- the test that required fasting, a blood sample, drinking a sweet drink & another blood sample after 2 hrs) If yes: Who advised you to have this test? It can be more than one: (can be read) Dr / Gest Diabetes Gr / Diabetes Educator / anti- natal clinic / Diabetes Aust-NDSS / friends / DK / Other: ________________________________________ (prompt: where were you advised to have this; where did you read about this) When approx. did you have the test? ________________________________________ / DK Do you mind telling me your test results? Normal / IGT - Pre diabetes / T2D / DK (if normal/DK/refuse) When will you have the test again? ____________________________ / DK ‘Thanks– this testing is important, approximately one in two women who develop gestational diabetes will go on to develop T 2 diabetes#. It’s generally recommended you have an oral glucose tolerance test every 2 years or more often as directed. And you will need to organize this with your GP….’ (If appropriate) Any changes to when will you have the test again? _____________________ / DK ‘If you have any questions about your diabetes testing contact your GP or the Central Coast Diabetes Centre on 4320 3321’ TO END (if IGT – Prediabetes) Thanks, there will be no more questions. This testing is important, approximately one in two women who develop gestational diabetes will go on to develop T 2 diabetes. You’ll be in the care of your GP or other health professional. You can also contact the Central Coast Diabetes Centre if you have other questions (4320 3321). TO END (if T2D) Thanks, there will be no more questions. You’ll be in the care of your GP or other health professional. You can also contact the Central Coast Diabetes Centre if you have other questions (4320 3321). TO END END – ‘Thanks again for your time bye….’ # Diabetes Aust – media release Version: 8.11.2010
  • 3. If no/DK: Do you recall being advised to have an oral glucose tolerance test about 6-8 weeks after having your baby? Y / N / DK If yes: Who advised you to have this test? It can be more than one: (READ) Dr / Gest Diabetes Gr / Diabetes Educator / anti-natal clinic / Diabetes Aust-NDSS / friends / DK / Other: ________________________________________ What are the reasons you didn’t have the test? _________________________________________________ ___________________________________________________________________________________ / DK Script? _______________________________________ (as appropriate) Extension: Do you intend to have the test? Y / N / DK OR Extension: When will have the test? _____________________________________ / DK (as appropriate) When will you have the test after this? ________________________________________ / DK TO END If no/DK: ‘It is generally recommended that you have an oral glucose tolerance test 6-8 weeks after birth to check if your sugar levels have returned to the normal range. And you organize this with your GP’ Will you have the test in the next 2 months? Y / N / try to / DK If no: Why not? _____________________________________________________ (as appropriate) Will you have a test in the future? Y / N / DK When? _____________________ TO END END- ‘Thanks – this testing is important, approximately one in two women who develop gestational diabetes will go on to develop T 2 diabetes#. It’s generally recommended you have an oral glucose tolerance test every 2 years or more often as directed. And you will need to organize this with your GP. If you have any questions about your diabetes testing contact your GP or the Central Coast Diabetes Centre on 4320 3321. Thanks again for your time bye…’ # Diabetes Aust – media release Version: 8.11.2010