At OU, 8% of pregnant patients have gestational diabetes. 18% of patients with gestational diabetes undergo screening for diabetes in the postpartum period. Barriers to obtaining screening at the postpartum visit include afternoon appointments, patients not fasting, lack of knowledge about length of testing, postpartum visit being at different clinic from where they obtained prenatal care. Current practice at OU does not involve specific instructions at time of discharge from the hospital.

We hypothesized that if there were specific instructions given to patients at time of discharge, they would be more likely to be prepared at postpartum visit to obtain screening test for diabetes, i.e., morning appointments, fasting, prepared to stay 2 hours. The objective was to increase awareness to patients regarding the risk of developing diabetes and improve the number of gestational diabetic patients who attend 6-week postpartum visit and obtain a 2-hour glucose tolerance test (GTT) to screen for diabetes.

A list of patients was generated including name and medical record number from all deliveries from 8/1/23 to 9/30/23 and from 12/1/2023 to 1/31/2024 at the University of Oklahoma. Patients with gestational diabetes were included in the study. After including all patients with gestational diabetes, the following information was collected: type of gestational diabetes, fasting finger stick blood sugar on postpartum day 1, attendance at postpartum visit, completion of 2-hour GTT, and site of prenatal care.

The intervention included a standard discharge order set with the ability to select specific discharge instructions for patients with gestational diabetes. The instructions say, "Please come to 6-week postpartum visit fasting (nothing to eat or drink for 8 hours prior to visit) to test for diabetes outside of pregnancy. This is a 2-hour test where you drink a sugary drink and have blood drawn."

1256 deliveries were performed at OUMC throughout the study period from 8/1/23 to 9/30/23 and from 12/1/2023 to 1/31/2024. 109/1256 (8.7%) patients had gestational diabetes. 11/60 (18.3%) of these patients obtained a 2-hour GTT during pre-intervention compared to 10/49 (20.4%) of patients post-intervention (p = 0.39, CI 95%).

This project demonstrated that despite implementation of specific discharge instructions, there was not a statistically significant increase in patients who obtained their 2-hour GTT postpartum. This suggests that even when patients are aware they need a 2-hour GTT, other barriers are playing a more significant role.