diabetes research and clinical practice 106 (2014) e11
Contents available at ScienceDirect
Diabetes Research and Clinical Practice journ al h ome pa ge : www .elsevier.co m/lo cate/diabres
Letter to the Editor Improving the response to post partum dysglycaemia screening in women with previous gestational diabetes mellitus We thank Capula et al. [1] for their interesting study confirming the high prevalence of glucose intolerance in the postpartum period in women with previous gestational diabetes mellitus (GDM). Actually, the major issue is that a high proportion of the women with GDM do not present for the postpartum glucose tolerance screening and follow-up: 47% in the monocentric study of Werner et al. [2], two thirds in our collaborative multicentric study [3]. McGovern et al. [4] also recently found, from a British multicentric retrospective cohort study including 127 primary care practices and 2016 women with GDM, that postpartum follow-up could be performed in only 18.5% of these women within 6 months of delivery. These studies indicate that publications of guidelines for the Diabetes in Pregnancy (National Institute for Health and Care Excellence in 2008, Socie´te´ Franc¸aise de Diabe´tologie and Colle`ge National des Gyne´cologues Obste´triciens Franc¸ais in 2010) have still had no effect on postpartum screening rates. And yet, Bao et al. [5] recently showed that increasing physical activity may lower the risk of progression from GDM to type 2 diabetes mellitus (T2DM), fully justifying active screening in these women. In this regard, the primary care providers (PCP) could play a key role in the response of the patients to post-partum screening after GDM, in the prevention of future dysglycaemia and T2DM. However, substantial regional differences among rates of follow-up by PCP prior to pregnancy may be observed in a whole country [4]. Future progress could also arise from more active information campaign [3], and perhaps more targeted follow-up of the women at highest risk, taking also into account risk estimates for future diabetes and modifiable risk factors, particularly body mass and lifestyle alterations [6]. Multicentric studies evaluating customized follow-up and care could help optimize the way to drive appropriate use of available health care resources.
references
[1] Capula C, Chiefari E, Vero A. Prevalence and predictors of postpartum glucose intolerance in Italian women with gestational diabetes mellitus. Diabetes Res Clin Pract 2014;105:223–30. [2] Werner EF, Tarabulsi G, Han C, Satin A. Early postpartum diabetes screening for women with gestational diabetes mellitus. Obstet Gynecol 2014;123(Suppl. 1):82S. [3] Bihan H, Cosson E, Khiter C, Vittaz L, Faghfouri F, Leboeuf D, et al. Factors associated with screening for glucose abnormalities after gestational diabetes mellitus: baseline cohort of the interventional IMPACT study. Diabetes Metab 2014;40:151–7. [4] McGovern A, Butler L, Jones S, van Vlymen J, Sadek K, Munro N, et al. Diabetes screening after gestational diabetes in England: a quantitative retrospective cohort study. Br J Gen Pract 2014;64:e17–23. [5] Bao W, Tobias DK, Bowers K. Physical activity and sedentary behaviors associated with risk of progression from gestational diabetes mellitus to type 2 diabetes mellitus: a prospective cohort study. JAMA Intern Med 2014;174: 1047–55. [6] Kim C. Maternal outcomes and follow-up after gestational diabetes mellitus. Diabetes Med 2014;31:292–301.
Lionel Carbillona,* Paul Valensib Emmanuel Cossonb a AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cite´, Department of Obstetrics and Gynecology, Bondy, France b Department of Endocrinology-Diabetology-Nutrition, Bondy, France *Correspondence to: Department of Obstetrics and Gynecology, Hoˆpital Jean Verdier, Avenue du 14 juillet, 93143 Bondy, France E-mail address: [email protected] (L. Carbillon) 21 August 2014 Available online 4 September 2014 http://dx.doi.org/10.1016/j.diabres.2014.08.015 0168-8227/# 2014 Elsevier Ireland Ltd. All rights reserved.
Contents available at ScienceDirect
Diabetes Research and Clinical Practice journ al h ome pa ge : www .elsevier.co m/lo cate/diabres
Letter to the Editor Improving the response to post partum dysglycaemia screening in women with previous gestational diabetes mellitus We thank Capula et al. [1] for their interesting study confirming the high prevalence of glucose intolerance in the postpartum period in women with previous gestational diabetes mellitus (GDM). Actually, the major issue is that a high proportion of the women with GDM do not present for the postpartum glucose tolerance screening and follow-up: 47% in the monocentric study of Werner et al. [2], two thirds in our collaborative multicentric study [3]. McGovern et al. [4] also recently found, from a British multicentric retrospective cohort study including 127 primary care practices and 2016 women with GDM, that postpartum follow-up could be performed in only 18.5% of these women within 6 months of delivery. These studies indicate that publications of guidelines for the Diabetes in Pregnancy (National Institute for Health and Care Excellence in 2008, Socie´te´ Franc¸aise de Diabe´tologie and Colle`ge National des Gyne´cologues Obste´triciens Franc¸ais in 2010) have still had no effect on postpartum screening rates. And yet, Bao et al. [5] recently showed that increasing physical activity may lower the risk of progression from GDM to type 2 diabetes mellitus (T2DM), fully justifying active screening in these women. In this regard, the primary care providers (PCP) could play a key role in the response of the patients to post-partum screening after GDM, in the prevention of future dysglycaemia and T2DM. However, substantial regional differences among rates of follow-up by PCP prior to pregnancy may be observed in a whole country [4]. Future progress could also arise from more active information campaign [3], and perhaps more targeted follow-up of the women at highest risk, taking also into account risk estimates for future diabetes and modifiable risk factors, particularly body mass and lifestyle alterations [6]. Multicentric studies evaluating customized follow-up and care could help optimize the way to drive appropriate use of available health care resources.
references
[1] Capula C, Chiefari E, Vero A. Prevalence and predictors of postpartum glucose intolerance in Italian women with gestational diabetes mellitus. Diabetes Res Clin Pract 2014;105:223–30. [2] Werner EF, Tarabulsi G, Han C, Satin A. Early postpartum diabetes screening for women with gestational diabetes mellitus. Obstet Gynecol 2014;123(Suppl. 1):82S. [3] Bihan H, Cosson E, Khiter C, Vittaz L, Faghfouri F, Leboeuf D, et al. Factors associated with screening for glucose abnormalities after gestational diabetes mellitus: baseline cohort of the interventional IMPACT study. Diabetes Metab 2014;40:151–7. [4] McGovern A, Butler L, Jones S, van Vlymen J, Sadek K, Munro N, et al. Diabetes screening after gestational diabetes in England: a quantitative retrospective cohort study. Br J Gen Pract 2014;64:e17–23. [5] Bao W, Tobias DK, Bowers K. Physical activity and sedentary behaviors associated with risk of progression from gestational diabetes mellitus to type 2 diabetes mellitus: a prospective cohort study. JAMA Intern Med 2014;174: 1047–55. [6] Kim C. Maternal outcomes and follow-up after gestational diabetes mellitus. Diabetes Med 2014;31:292–301.
Lionel Carbillona,* Paul Valensib Emmanuel Cossonb a AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cite´, Department of Obstetrics and Gynecology, Bondy, France b Department of Endocrinology-Diabetology-Nutrition, Bondy, France *Correspondence to: Department of Obstetrics and Gynecology, Hoˆpital Jean Verdier, Avenue du 14 juillet, 93143 Bondy, France E-mail address: [email protected] (L. Carbillon) 21 August 2014 Available online 4 September 2014 http://dx.doi.org/10.1016/j.diabres.2014.08.015 0168-8227/# 2014 Elsevier Ireland Ltd. All rights reserved.
