Association of Gestational Diabetes Clinician Type with Postpartum Screening and Risk of Type 2 Diabetes Mellitus.

OBJECTIVE

To evaluate whether the clinician specialty managing gestational diabetes mellitus (GDM) during pregnancy is associated with postpartum 2-hour oral glucose tolerance testing (OGTT) completion and long-term risk of type 2 diabetes mellitus (T2DM).

STUDY

DESIGN

We performed a retrospective cohort study of individuals with GDM who delivered at a single academic center from 2016 to 2020. Patients were categorized according to primary GDM managing clinician type: Maternal-Fetal Medicine (MFM), Endocrinology (Endo), or Obstetrics/Family Medicine (OB/FM). The primary outcome was completion of postpartum 2-hour OGTT within 12 weeks of delivery. Secondary outcomes included abnormal postpartum OGTT and diagnosis of T2DM within 5 years postpartum. Multivariable logistic regression models were adjusted for nulliparity, GDM managed with medications, insurance status, and chronic hypertension.

RESULTS

Among 715 individuals with GDM, 27% were managed by MFM, 20% by Endo, and 53% by OB/FM. Overall, 13.3% were diagnosed with T2DM within 5 years postpartum. Postpartum OGTT completion rates were similar among Endo (29.8%), MFM (24.2%), and OB/FM (26.1%) groups (p = 0.52). In adjusted analyses, clinician type was not associated with completion of postpartum OGTT or abnormal OGTT results. Compared with endocrinology management, OB/FM care was associated with lower crude odds of T2DM diagnosis at 5 years (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.30-0.99), although this association was no longer significant after adjustment (adjusted OR [aOR], 0.56; 95% CI, 0.30-1.06).

CONCLUSION

Clinician specialty type managing GDM was not associated with postpartum diabetes screening completion or long-term risk of T2DM. These findings suggest that provider specialty alone may not meaningfully influence postpartum diabetes surveillance or long-term metabolic outcomes and underscore the need for system-level interventions to improve care transitions after GDM, such as immediate postpartum testing during hospital stay after birth.

KEY POINTS: · Postpartum oral glucose tolerance test completion was low across specialties.. · Clinician type was not linked to oral glucose tolerance test completion.. · T2DM risk did not differ by clinician specialty type at 5 years..