title: Preventive letter: doubling the return rate after gestational diabetes mellitus.
abstract: To measure the impact of a "Preventive Letter" designed to encourage the return of gestational diabetes mellitus (GDM) mothers to follow up visit after delivery, in the context of a worldwide concern about low return rates after delivery of these patients. Mothers with GDM require medical evaluation and an oral glucose tolerance test (OGTT) 6 weeks after delivery, in order to: [a] confirm remission of GDM and [b] provide advice on the prevention of type 2 diabetes. In the year 2003 we developed a "Preventive Letter", containing three aspects: [a] current treatment, [b] suggested management during labor, and [c] a stapled laboratory order for OGTT to be performed 6 weeks after delivery. The return rate after delivery was assessed in two groups of GDM mothers: [a] "Without Preventive Letter" (n = 253), and "With Preventive Letter" (n = 215). Both groups, similar with respect to age (33.0 ± 5.4 and 32.3 ± 4.9 years respectively, p = 0.166) and education time (14.9 ± 1.8 and 15.0 ± 1.8 years respectively, p = 0.494), showed a significant difference in the 1-year return rate after delivery, as assessed by the Kaplan-Meier test: 32.0 % for the group "Without Preventive Letter", and 76.0 % for the group "With Preventive Letter" (p < 0.001). The 1-year return rate after delivery of GDM mothers was 2.4 times higher in the group "With Preventive Letter" than in the group without it. We believe that this low-cost approach could be useful in other institutions caring for pregnant women with diabetes.
authors.affiliation: Department of Nutrition, Pontificia Universidad Católica de Chile, Santiago, Chile, polmos@med.puc.cl.
authors.forename: Pablo R
authors.initials: PR
authors.lastname: Olmos
authors.forename: Gisella R
authors.initials: GR
authors.lastname: Borzone
authors.forename: Loni
authors.initials: L
authors.lastname: Berkowitz
authors.forename: Nicolás
authors.initials: N
authors.lastname: Mertens
authors.forename: Dolores
authors.initials: D
authors.lastname: Busso
authors.forename: José L
authors.initials: JL
authors.lastname: Santos
authors.forename: José A
authors.initials: JA
authors.lastname: Poblete
authors.forename: Claudio
authors.initials: C
authors.lastname: Vera
authors.forename: Cristián
authors.initials: C
authors.lastname: Belmar
authors.forename: Denisse
authors.initials: D
authors.lastname: Goldenberg
authors.forename: Bárbara
authors.initials: B
authors.lastname: Samith
authors.forename: Ana M
authors.initials: AM
authors.lastname: Acosta
authors.forename: Manuel
authors.initials: M
authors.lastname: Escalona
mesh_terms: D000328:Adult; D000596:Amino Acids; D002096:C-Peptide / Q000097:blood; D002677:Chile; D002857:Chromium; D015709:Correspondence as Topic; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D016640:Diabetes, Gestational / Q000097:blood / Q000628:therapy; D005260:Female; D006293:Health Promotion / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D009539:Nicotinic Acids; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011181:Postnatal Care / Q000379:methods; D011247:Pregnancy; D012577:Schools, Medical
chemical_list: D000596:Amino Acids; D002096:C-Peptide; D009539:Nicotinic Acids; C015240:glucose tolerance factor; D002857:Chromium