Gestational Diabetes Follow Up Study

As Los Angeles County + University of Southern California Women and Children's Hospital
(LAC+USC WCH) serves an indigent Latino population at increased risk for developing Type 2
Diabetes Mellitus (T2DM), Gestational Diabetes Mellitus (GDM) complicated 13% of deliveries
at LAC+USC WCH between 2006-2007. While over 50% of GDM patients will develop overt diabetes
mellitus within a decade of the incident pregnancy, less than half of these patients ever
return for even one post-partum follow up visit at this institution (45%). Lifestyle
Interventions and medications have been shown to delay or prevent the onset of T2DM.
However, prevention is only possible if patients follow-up and individual risk assessment is
made. While identifying the 2-hour glucose tolerance test as the appropriate postpartum
screening technique for patients with a history of GDM, the Fifth International
Workshop-Conference on Gestational Diabetes Mellitus did not identify strategies to improve
follow up among this patient population. Promotoras (bi-lingual, bi-cultural lay community
health workers representative of the Latino community base) have been successful in
improving follow up for other areas of diabetes and women's preventive services but have not
been studies in the context of GDM. In this randomized control trial (RCT), 230 subjects
completing a GDM affected pregnancy will be randomized on the postpartum ward to the
standard-of-care versus proactive follow-up with a Promotora. The Promotora will provide
education, address barriers to follow-up, remind subjects of their appointments, and call
them to reschedule if they miss appointments. In the first phase of the study, these
appointments will include the OGTT and the initial postpartum visit. In the second phase,
these visits will include referrals to internal medicine (for those diagnosed with T2DM) or
nutrition counseling (for those found not to have diabetes). The primary hypothesis
underlying this proposal is that the introduction of a Promotora providing education and
pro-active follow-up into postpartum GDM management will result improve post-partum
follow-up for screening, treatment, and preventive services when compared with the standard
of care.