Increasing Postpartum Detection of Type 2 Diabetes

CLINICAL PRIORITY

Women’s Health program leaders at ChristianaCare endeavored to improve postpartum screening rates for type 2 diabetes among women with gestational diabetes.

Poor compliance with the two-hour oral glucose tolerance testing (2hr OGTT) at 6-12 weeks postpartum is attributed to the stress of caring for a new child and challenges with appointment logistics exacerbated by demanding work schedules, wait times, childcare, and transportation. Barriers to screening are higher among women of low income and racial minority communities.

"The text-based messaging program increased screening compliance by 92 percent, which improved our disease detection rates and alleviated racial disparities in healthcare."
Helen Gomez, MD, ChristianaCare

APPROACH

ChristianaCare investigated the effectiveness of text-based mobile messaging and in-home fasting blood sugar (FBS) in the detection of type 2 diabetes compared to traditional 2hr OGTT.

ChristianaCare partnered with Twistle by Health Catalyst to provide smartphone-based patient engagement; patients used glucometers and lancets that they were also using during pregnancy. Preconfigured communication pathways delivered time-based, HIPAA-compliant education and reminders, and captured FBS data using easy-to-complete forms. 

Patients received appropriate automated text replies and if warranted, data was escalated to clinical staff for additional intervention. Participants could also engage with clinical staff asynchronously to address questions or issues.

"We found many more women who are diabetic with the Twistle by Health Catalyst platform. Why? Radical convenience!"
Matthew Hoffman, MD, Christianacare

STUDY DESIGN

ChristianaCare conducted a prospective cohort study 1 of postpartum women with gestational diabetes.

• 239 women received a 2hr OGTT at 6-12 weeks postpartum.
• The dual care group composed of 207 women recorded FBS for 3 consecutive days using the mobile application and completed the standard 2hr OGTT if the results were equivocal.

The study assessed agreement with 2hr OGTT using sensitivity, specificity, positive and negative predictive value with exact binomial 95 percent confidence intervals.

RESULTS

• Text-based screening led to a 92 percent increase in compliance* rates compared to standard screening (25 percent vs. 48 percent), and a 213 percent increase in the detection of type 2 diabetes (5.4 percent in the 2hr OGTT group compared to 16.9 percent in text-based screening).
• Engagement with the in-home screening resulted in a 211 percent increase in compliance among Black women (11.1 percent vs. 34.5 percent) and narrowed the racial gap in care.
• Improvements in compliance with text-based care resulted in a 180 percent higher diabetes detection rate among non-Black women (6.2 percent vs. 17.4 percent) and a 577 percent increase among Black women (2.1 percent vs. 13.8 percent).

* Compliance was measured by the percentage of women who submitted all three fasting values.