A FOLLOW-UP PROGRAM FOR WOMEN WITH PREVIOUS GESTATIONAL DIABETES-MELLITUS

Objective: To analyse the patterns of attendance in a gestational diab etes mellitus (GDM) follow-up program for detection of impaired glucos e tolerance and diabetes mellitus. Design: Retrospective cohort study using computerised data from the GDM follow-up program. Participants a nd setting: All women with GDM who delivered at the Mercy Hospital for Women in Victoria between 1 January 1981 and 31 December 1995. Outcom e Measures: Enrolment and maintenance in the follow-up program. Predic tors of attendance analysed were attendance for the postnatal oral glu cose tolerance test (OGTT), severity of GDM, insulin requirement in pr egnancy, age at index pregnancy, country of birth, patient booking sta tus and year of index pregnancy. Results: There were 3524 women with G DM delivered during the study period. Attendance for postnatal OGTT wa s 71% and increased from 43.7% to 69.5% to 84.4% during the three five -year periods of the study (P<0.00001). Entry into the follow-up progr am was 58% (1743 of 2986 eligible). A further 538 women (15.3%) were a waiting the postnatal OGTT or first follow-up OGTT. By December 1995, 45% of women who had entered the program had been lost to follow-up. E nrolment in the follow-up program was significantly predicted by insul in requirement in pregnancy (odds ratio [OR], 2.22; 95% confidence int erval [95% CI], 1.57-3.13), attendance for postnatal OGTT (OR, 1.94; 9 5% CI, 1.64-2.29), private patient status (OR, 1.31; 95% CI, 1.12-1.54 ), severity of GDM (OR, 1.50; 95% CI, 1.24-1.82) and age 30 years or m ore (OR, 1.37; 95% CI, 1.17-1.60). Maintenance in the follow-up progra m was significantly associated with attendance for postnatal OGTT (OR, 2.67; 95% CI, 2.19-3.24), insulin requirement in pregnancy (OR, 2.56; 95% CI, 1.87-3.50), age 30 years or more (OR, 1.59; 95% CI, 1.34-1.88 ) and severity of GDM (OR, 1.55; 95% Cl, 1.28-1.89). Conclusions: Ther e are major difficulties with both recruiting women with GDM into a fo llow-up program and ensuring their continued attendance. However, a po stnatal OGTT and consultation is the most important remediable factor for continuation in a follow-up program. The dedication of the follow- up team administrators rather than the clinical variables of the patie nts was probably the main determinant of compliance with the follow-up program.