Barriers to completing oral glucose tolerance testing in women at risk of gestational diabetes.
Diabetic medicine : a journal of the British Diabetic Association
MetadataShow full item record
Lachmann, E., Fox, R., Dennison, B., Usher-Smith, J., Meek, C., & Aiken, C. (2020). Barriers to completing oral glucose tolerance testing in women at risk of gestational diabetes.. Diabetic medicine : a journal of the British Diabetic Association, 37 (9), 1482-1489. https://doi.org/10.1111/dme.14292
Aims: Complications of gestational diabetes can be mitigated if the diagnosis is recognised. However, some at-risk women do not complete antenatal diagnostic oral glucose tolerance testing (OGTT). We aimed to understand reasons contributing to non-completion, particularly to identify modifiable factors. Methods: 1,906 women attending a tertiary UK obstetrics centre (2018-2019) were invited for OGTT based on risk-factor assessment. Demographic information, test results, and reasons for non-completion were collected from the medical record. Logistic regression was used to analyse factors associated with non-completion. Results: 13% (n=242) of women did not complete at least one OGTT, of whom 32% (n=78) never completed testing. In adjusted analysis, any non-completion was associated with younger maternal age (≤30 years; OR 2.3, 95% CI;1.6-3.4, p<0.001), Black African ethnicity (OR 2.7, 95% CI;1.2-5.5, p=0.011), lower socio-economic status (OR 0.9, 95% CI;0.8-1.0, p=0.021) and higher parity (≥2; OR 1.8, 95% CI;1.1-2.8, p=0.013). Non-completion was more likely if testing indications included BMI ≥30kg/m2 (OR 1.7, 95% CI;1.1-2.4, p=0.009) or family history of diabetes (OR 2.2, 95% CI;1.5-3.3, p<0.001) and less likely if the indication was an ultrasound finding (OR 0.4, 95% CI;0.2-0.9, p=0.035). We identified a common over-lapping cluster of reasons for non-completion, including inability to tolerate test protocol (21%), social/mental health issues (22%), and difficulty keeping track of multiple antenatal appointments (15%). Conclusions: There is a need to investigate methods of testing that are easier for high-risk groups to schedule and tolerate, with fuller explanation of test indications and additional support for vulnerable groups.
Catherine Aiken is supported by an Isaac Newton Trust[12.21(a)]/Wellcome Trust ISSF [105602/Z/14/Z]/ University of Cambridge Joint Research Grant. Claire Meek is supported by the Diabetes UK Harry Keen intermediate clinical fellowship (17/0005712) and the European Foundation for the Study of Diabetes/ Novo Nordisk Foundation Futures Leader’s Award (NNF19SA058974). Juliet Usher-Smith is supported by a Cancer Research UK Prevention Fellowship (C55650/A21464).
Cancer Research UK (21464)
Diabetes UK (17/0005712)
WELLCOME TRUST (105602/Z/14/Z)
Embargo Lift Date
External DOI: https://doi.org/10.1111/dme.14292
This record's URL: https://www.repository.cam.ac.uk/handle/1810/302421
Attribution 4.0 International (CC BY)
Licence URL: http://creativecommons.org/licenses/by/4.0/