• Christinna Rebecca Olesen
  • Jane Hyldgård Nielsen
4. term, Public Health, Master (Master Programme)
Abstract
Introduction: A Danish follow-up study, shows that 40% of women with a history GDM mellitus (GDM)
develops type 2 diabetes mellitus within a ten-year period. The women are recommend follow-up screening
every 1-2 years after birth. Low participation in the recommended follow-up screening among women with
previous GDM, was found in the region of North Jutland. Women who participated in the follow-up screening
had a greater possibility of diagnosis with diabetes and initiation of treatment with glucose lowering agents.
Participating women furthermore had an increased possibility of early detection in relation to both earlier
diagnosis and treatment. In this context, there is an unexploited potential in prevention of diabetes among
the women, which is unsatisfying with regard to the health consequences among the non-participating
women.
Aim: To gain insight into reasons for the low participation in the follow -up screening related to treatment
and care among women with previous GDM in the region of North Jutland. The women’s experiences can be
the offset for the development of an intervention to increase the participation in follow-up that can be a part
of the future management, implementation and organization of follow -up screening for GDM in the region
and possibly Denmark.
Method: A single case '' embedded '' design to investigate women with previous GDM experiences with their
treatment and care at the clinic of women- child and urinary surgery the department of gynecology and
obstetrics at Aalborg University Hospital examined through women experiences of patient care. The data
collection method was semi-structured research interviews. In cooperation with the department at Aalborg
Hospital University Hospital North 40 women with previous GDM, was invited to participate in the study.
Seven informants participated in the final study.
Result: The women experienced inconsistency in transitions, which was cause by insufficient information and
lack of coordination and clear responsibility for follow-up screening. Furthermore, the women expressed a
lack of focus, clarity and inclusion of their individual needs and preferences of patient care and general lack
of “shared decision- making'', including lack of patient centeredness. The women consider follow-up
screening as important and want to participate, but is a possibility that the content of information on
participation in follow-up screening is not adapted to their own behavior. The women expressed needs
regarding consideration of their individual situation and to be reminded of follow-up screening, as it was
believed to contribute to peace and comfort for the women.
Discussion: From a system perspective on the women's experiences of patient care the procedures are not
sufficiently contributing to continuity of care for the women, which can be related to the clinical procedures
that does not ensure the transfer of information in vulnerable and social processes that occurs in transitions.
This can result in women not being informed about their treatment and care at the various departments and
at their general practitioner. The women’s experiences shows grounds for a patient centered approach to
ensure focus on and consideration of the women's needs and desires for more meaning and continuity in
treatment and care.
Conclusion: A development effort or intervention to increase participation in follow-up screening can be
based on the postal reminders to women, which can increase the participation in follow-up screening, and
act as a barrier for the insufficient information. Increased patient centeredness in the women's overall
patient care, including support in decision making can contribute to increased meaningfulness in the
women's experience of patient care. Involvement of the women's experiences of continuity and meaning in
patient care are involved it can strengthened their decision-making process, which eventually can contribute
to increased participation in follow-up screening

Abstract
Background: Women whose pregnancy was complicated by gestational diabetes have a 7-fold higher risk of
developing diabetes, primarily type 2. Early detection can prevent or delay the onset of late complications,
for which follow-up screening is important. This study investigated the extent of participation in follow-up
screening and the possible consequences of nonattendance.
Method: In Danish national registers covering the years 1994-2011 we identified 2171 birthing women whose
pregnancy was complicated by first-time gestational diabetes. Control visits to general practitioners and
biochemical departments after giving birth were charted. Following national guidelines we defined four
intervals for assessment of participation in follow-up screening. Diagnosis of diabetes or treatment with
glucose-lowering agents after giving birth were also identified. Participation in follow-up screening and risk
of diabetes was calculated. Time to obtaining diagnosis of diabetes or initiating treatment was analysed by
Cox regression models. All models were adjusted for age, ethnicity and income.
Results: High attendance was found during the first control interval, after which attendance decreased with
time after giving birth for both controls at general practitioners and biochemical departments. All differences
in proportions were statistically significant. Women attending controls at general practitioners had a
significantly higher risk of diabetes diagnosis and treatment after gestational diabetes than women not
attending. The results for women attending testing at biochemical departments also showed an increased
risk of initiation of treatment. Women attending at least one general practitioners control had a significantly
higher risk of early diabetes diagnosis or treatment. Time to initiation of treatment was significantly higher
for testing at biochemical departments. Women with high incomes had a significantly lower risk of diabetes
diagnosis or initiation of treatment compared to low-income women.

Conclusion: Participation in follow-up screening after gestational diabetes is low. Follow-up screening
ensures early detection of diabetes and initiation of treatment. Our results emphasize the importance of
stimulating participation for early detection and prevention of diabetes after gestational diabetes.
LanguageDanish
Publication date30 Jun 2014
Number of pages132
External collaboratorGynækologisk-obstetrisk afdeling Aalborg Universitetshospital
Overlæge Margrethe Møller amm@rn.dk
Other
ID: 198396663