BMJ open · 2025
Postpartum diabetes screening for women with gestational diabetes in Japan: an administrative database study.
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Yoshioka Toshiki, Shikata Masataka, Nakanishi Sayuri, Kurasawa Kentaro, Aoki Shigeru, Miyagi Etsuko, Goto Atsushi
Аннотация
OBJECTIVES: To estimate uptake of the 75 g oral glucose tolerance test (OGTT) at 6-12 weeks postpartum among women with gestational diabetes mellitus (GDM) in Japan, and to explore the demographic and clinical characteristics associated with screening uptake.
DESIGN: Retrospective cohort study using administrative claims data.
SETTING: Data from a nationwide employees' health insurance claims database (Japan Medical Data Center; JMDC) during the fiscal years 2012-2020 were assessed.
PARTICIPANTS: 2282 women with GDM in the JMDC claims database (April 2012-January 2021), ascertained using the International Classification of Diseases 10th revision (ICD-10) codes cross-validated with a high-risk GDM management fee.
PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome: completion of a 75 g OGTT at 6-12 weeks postpartum.
SECONDARY OUTCOMES: completion of a 75 g OGTT at 4-12 weeks postpartum and cumulative completion up to 1 year postpartum.
RESULTS: We included 2282 women in the analysis. The overall screening rate was 28.7% (654/2282) from 2012 to 2020. Even in 2020, the year with the highest reported screening rate, it remained low at 33.2% (181/546). After expanding the range to include 4 weeks to ≤1 year postpartum, the cumulative screening rate reached 64.9% by 1 year postpartum. The screening rate was lower when childbirth and GDM were managed at different facilities than when both were managed within the same facility.
CONCLUSIONS: We report suboptimal screening rates for women with a GDM history in Japan. This study highlights the need for continuous monitoring and the development of effective strategies for early screening and intervention in this high-risk group. These strategies should include system-level improvements in screening methods and enhance patient awareness through antenatal education prior to delivery.
DESIGN: Retrospective cohort study using administrative claims data.
SETTING: Data from a nationwide employees' health insurance claims database (Japan Medical Data Center; JMDC) during the fiscal years 2012-2020 were assessed.
PARTICIPANTS: 2282 women with GDM in the JMDC claims database (April 2012-January 2021), ascertained using the International Classification of Diseases 10th revision (ICD-10) codes cross-validated with a high-risk GDM management fee.
PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome: completion of a 75 g OGTT at 6-12 weeks postpartum.
SECONDARY OUTCOMES: completion of a 75 g OGTT at 4-12 weeks postpartum and cumulative completion up to 1 year postpartum.
RESULTS: We included 2282 women in the analysis. The overall screening rate was 28.7% (654/2282) from 2012 to 2020. Even in 2020, the year with the highest reported screening rate, it remained low at 33.2% (181/546). After expanding the range to include 4 weeks to ≤1 year postpartum, the cumulative screening rate reached 64.9% by 1 year postpartum. The screening rate was lower when childbirth and GDM were managed at different facilities than when both were managed within the same facility.
CONCLUSIONS: We report suboptimal screening rates for women with a GDM history in Japan. This study highlights the need for continuous monitoring and the development of effective strategies for early screening and intervention in this high-risk group. These strategies should include system-level improvements in screening methods and enhance patient awareness through antenatal education prior to delivery.