title: Missed opportunities for diabetes prevention: post-pregnancy follow-up of women with gestational diabetes mellitus in England.
abstract: BACKGROUND
  Women with gestational diabetes mellitus (GDM) should be followed-up to exclude ongoing diabetes and for prevention of type 2 diabetes. The National Institute for Health and Clinical Excellence (NICE) diabetes in pregnancy guideline recommends checking fasting plasma glucose (FPG) at 6 weeks postpartum (short term), and annually thereafter (long term).
  
  
  OBJECTIVE
  To examine the reported practice regarding GDM follow-up.
  
  
  METHODS
  Nationwide postal survey in England 2008-2009.
  
  
  METHODS
  Questionnaires were distributed to a consultant diabetologist and obstetrician in all maternity units, and to a random sample of general practices (approximately 1 in 5).
  
  
  RESULTS
  Response rates were: 60% (915/1532) GPs, 93% (342/368) specialists; 80% of GPs and 98% of specialists reported women with GDM had short-term follow-up. More GPs (55%) than specialists (13%) used a FPG test to exclude ongoing diabetes; 26% of GPs versus 89% of specialists thought the hospital was responsible for ordering the test. Twenty per cent of GPs had difficulty in discovering women had been diagnosed with GDM in secondary care. Seventy-three per cent of specialists recommended long-term follow-up; only 39% of GPs recalled women with GDM for this. A minority of GPs and specialists had joint follow-up protocols.
  
  
  CONCLUSIONS
  Follow-up of GDM in England diverged from national guidance. Despite consensus that short-term follow-up occurred, primary and secondary care doctors disagreed about the tests and responsibility for follow-up. There was lack of long-term follow-up. Agreement about the NICE guideline, its promotion and effective implementation by primary and secondary care, and the systematic recall of women with GDM for long-term follow-up is required.
authors.affiliation: Medical Research Council, Unit for Lifelong Health and Ageing, London. m.pierce@nshd.mrc.ac.uk
authors.forename: Mary
authors.initials: M
authors.lastname: Pierce
authors.forename: Jo
authors.initials: J
authors.lastname: Modder
authors.forename: Iman
authors.initials: I
authors.lastname: Mortagy
authors.forename: Anna
authors.initials: A
authors.lastname: Springett
authors.forename: Heather
authors.initials: H
authors.lastname: Hughes
authors.forename: Stephanie
authors.initials: S
authors.lastname: Baldeweg
mesh_terms: D001291:Attitude of Health Personnel; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D016640:Diabetes, Gestational / Q000517:prevention & control*; D042241:Early Diagnosis; D004739:England; D005260:Female; D005500:Follow-Up Studies; D058006:General Practice; D006801:Humans; D008134:Long-Term Care; D009774:Obstetrics; D011181:Postnatal Care; D011247:Pregnancy; D011364:Professional Practice; D011644:Puerperal Disorders / Q000517:prevention & control*; D014852:Wales