Follow-up Glucose Testing and Timely Transition to Primary Care after Gestational Diabetes

 描述（由申请人提供）：多达60%的受妊娠期糖尿病（GDM）影响的妊娠女性将在未来十年内发展为成人糖尿病（2型糖尿病或T2DM）。产后葡萄糖检测和分娩后在初级保健中的持续监测可以识别有风险的女性，预防或延迟T2DM的发作，并降低与疾病相关的并发症的严重程度。然而，只有不到一半的GDM孕妇接受葡萄糖检测，而且在第一次妊娠中很少有人从产科护理转到初级护理。 分娩后六个月。我们将分两步分析来自基于保险的大型数据系统（OPTUMTM）的数据。第一步是确定分娩后葡萄糖检测的障碍和促进因素，建议84天的时间，并过渡到初级保健继续监测。在第二步中，我们将分析检测和过渡到初级保健对GDM后健康结局（重复妊娠GDM、T2DM发作和BMI增加（作为T2DM风险增加的指标））的贡献。这种“大数据”方法将提供迄今为止最大的样本，以及第一次纵向分析，该分析从怀孕前开始，并跟踪同一名妇女分娩后三年。该数据集已被用于描述未诊断的糖尿病前期、糖尿病和妊娠糖尿病的经济负担所导致的医疗保健费用。我们提出的研究将调查个体和系统因素，解释为什么大多数GDM女性没有利用分娩后的机会来预防T2DM。

 DESCRIPTION (provided by applicant): As many as 60% of women with a pregnancy affected by gestational diabetes (GDM) will develop adult diabetes (Type 2 Diabetes Mellitus, or T2DM) in their next decade. Postpartum glucose testing and continued monitoring in primary care after delivery can identify women at risk, prevent or delay the onset of T2DM, and reduce the severity of complications associated with the disease. However, fewer than half of women with a GDM pregnancy get glucose tests, and very few transfer from obstetric care to primary care in the first six months after delivery. We will analyze data from a large insurance-based data system (OPTUMTM) in two steps. The first step is to identify barriers and facilitators to post-delivery glucose testing with the recommended 84 day period and transition to primary care for continued monitoring. In the second step, we will analyze the contribution of testing and transition to primary care to post-GDM health outcomes (repeat pregnancy with GDM, onset of T2DM, and increase in BMI (as a measure of increased risk for T2DM) within three years post- delivery. This 'big data' approach will provide the largest sample to date, and the first longitudinal analysis that begins prior to pregnancy and follows the same woman through for three years post-delivery. This data set has already been used to describe health care costs attributable to the economic burden of undiagnosed pre- diabetes, diabetes and gestational diabetes. Our proposed study will investigate both individual and systems factors that explain why the majority of women with GDM do not take advantage of post-delivery opportunities for prevention of T2DM.