TOPLINE:

Inpatient oral glucose tolerance test (OGTT) before delivery discharge for individuals with gestational diabetes mellitus (GDM) resulted in more than triple the completion rate compared to standard outpatient testing at 12 weeks postpartum. Among 104 participants randomly assigned, 92.3% in the inpatient group completed testing compared with 26.9% in the outpatient group, with significantly higher patient satisfaction scores in the inpatient group.

METHODOLOGY:

• Researchers conducted a pragmatic, nonblinded randomized controlled trial at a tertiary care academic medical center in the midwestern US from July 2023 to December 2024, enrolling 104 individuals with GDM.
• Participants were randomly assigned 1:1 after delivery to receive a fasting 2-hour 75-g OGTT either inpatient before delivery discharge (intervention group, n = 52) or outpatient within 12 weeks of birth (standard care group, n = 52).
• The primary outcome was completion of a fasting, 2-hour 75-g OGTT by 12 weeks postpartum or less, confirmed by study staff for inpatient testing and by chart review and patient survey for outpatient testing.
• Secondary outcomes included participant satisfaction measured by the adapted Diabetes Treatment Satisfaction Questionnaire and diagnosis of prediabetes (fasting 100-125 mg/dL or 2-hour 140-199 mg/dL) or type 2 diabetes (fasting ≥ 126 mg/dL or 2-hour ≥ 200 mg/dL).
• Sample size calculation was based on an estimated baseline testing rate of 52% and a treatment effect of at least 50%, requiring 104 participants with 80% power and a two-sided alpha of 0.05.

TAKEAWAY:

• Frequency of postpartum OGTT completion was significantly higher in the inpatient group than in the outpatient group (92.3% vs 26.9%; relative risk, 3.43; 95% CI, 2.18-5.40), corresponding to a risk difference of 65% (95% CI, 51%-79%).
• Patient satisfaction with testing measured by the Diabetes Treatment Satisfaction Questionnaire was significantly higher in the inpatient group than in the outpatient group, with median scores of 35.0 (interquartile range [IQR], 31.0-36.0) vs 28.0 (IQR, 24.0-32.0; P < .001).
• Prediabetes or type 2 diabetes was diagnosed in 50.0% of participants in the inpatient group compared with 21.4% in the outpatient group (P = .05).
• Postpartum visit completion exceeded 90% in both groups (92.3% inpatient, 94.2% outpatient), indicating that inpatient testing did not reduce subsequent postpartum care attendance.

IN PRACTICE:

“Diabetes testing before delivery discharge for individuals with GDM resulted in a higher completion rate of postpartum glucose testing and greater patient satisfaction compared with outpatient testing. This RCT [randomized controlled trial] supports recent guidelines that encourage the option of inpatient postpartum diabetes testing before delivery discharge,” the authors of the study wrote.

SOURCE:

The study was led by Christine Field, MD, MPH, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University in Columbus. It was published online in Obstetrics & Gynecology.

LIMITATIONS: 

The trial was conducted at a single site and enrolled participants with access to postpartum care, which may have reduced the likelihood of unmet social needs and potentially biased results toward the null, as individuals with prior GDM who experience more unmet social needs are less likely to complete postpartum testing. Data on participants who were eligible but declined to participate were not available, limiting understanding of potential selection bias. The estimates for secondary outcomes among the outpatient testing group may not be reliable given the relatively small sample size, as most individuals in that group did not complete an outpatient OGTT. Differential timing and mode of assessment for patient satisfaction surveys may have introduced bias, as inpatient participants completed surveys the same day as their test while outpatient participants may have completed surveys days or weeks later. Postdelivery randomization may affect generalizability by limiting participants to those able to consent postpartum and thus more likely to complete an inpatient test.

DISCLOSURES:

Christine Field, MD, MPH, received support from funding provided by the Institute for Population Research and core support from NIH center grant P2CHD058484 awarded by the National Institute of Child Health and Human Development. Kartik K. Venkatesh, MD, PhD, Jigiang Wu, MSc, and Shaylyn Vickers, CNP, received support from the Care Innovation and Community Improvement Program at The Ohio State University. The authors reported no potential conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.