title: Postpartum glucose follow-up and lifestyle management after gestational diabetes mellitus: general practitioner and patient perspectives.
abstract: BACKGROUND
  Incidence of type 2 diabetes is high after gestational diabetes mellitus (GDM). We aimed to evaluate the adherence to follow-up six-weeks postpartum visits in secondary care after GDM and glucose monitoring in primary care longer than 12-14 months after delivery and the years thereafter. In addition, we examined the women's lifestyle after delivery.
  
  
  METHODS
  A cross-sectional follow-up survey among women with a history of GDM and their general practitioners (GP). Rates of attendance at the six-weeks postpartum visit and glucose testing were obtained from hospital records, over the period 2011-2012. Rates of annual follow-up postpartum glucose testing were assessed by a survey among their GP's. Lifestyle of the women on diet and exercise was assessed by questionnaire in 2015.
  
  
  RESULTS
  In total 197 women were eligible for the study. Of these, 156 (79%) attended the six-weeks postpartum visit at the diabetes outpatient clinic and in 145 (93%) of these women glucose testing was performed. In total 77 (39%) women responded to the invitation to participate in this study and filled in the lifestyle questionnaire. About one third of the women met the recommendations for sufficient physical activity. A majority of them did not fulfil the Dutch guidelines on healthy diet - fruit intake 35.1%, vegetables intake 7.8%. Of the 74 invited GP's, 61 responded (82%), only 12 (20%) reported that they had performed a follow-up glucose testing within >12-14 months postpartum. Of these women, five were tested only in the first year of follow-up, five also in the second year, and two were tested for three consecutive years.
  
  
  CONCLUSIONS
  Despite the high attendance rate of six-weeks postpartum visit and glucose testing, we observed low rates of longer-term follow-up regarding postpartum glucose testing. Moreover, we found a suboptimal adherence to healthy lifestyle for women with a history of GDM.
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Koning
authors.affiliation: Department of Endocrinology, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Helen L
authors.initials: HL
authors.lastname: Lutgers
authors.affiliation: Department of Internal Medicine, Martini Hospital, Groningen, The Netherlands.
authors.forename: Klaas
authors.initials: K
authors.lastname: Hoogenberg
authors.affiliation: General Practitioners Practice Trompert, Zuidhorn, The Netherlands.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Trompert
authors.affiliation: Department of Gynaecology and Obstetrics, University of Groningen, University Medical Center, Groningen, The Netherlands.
authors.forename: Paul P
authors.initials: PP
authors.lastname: van den Berg
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: Bruce H R
authors.initials: BH
authors.lastname: Wolffenbuttel
keywords: Follow-up; General practitioner; Gestational diabetes mellitus; Glucose testing; Lifestyle; Postpartum