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Barriers to completing oral glucose tolerance testing in women at risk of gestational diabetes.

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Lachmann, EH 
Fox, RA 
Usher-Smith, JA 


AIM: Complications of gestational diabetes (GDM) can be mitigated if the diagnosis is recognized. 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: Some 1906 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: Some 242 women (12.3%) did not complete at least one OGTT, of whom 32.2% (n = 78) never completed testing. In adjusted analysis, any non-completion was associated with younger maternal age [≤ 30 years; odds ratio (OR) 2.3, 95% confidence interval (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 ≥ 30 kg/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 overlapping 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.



Adult, Age Factors, Black People, Diabetes, Gestational, Ethnicity, Female, Glucose Tolerance Test, Humans, Logistic Models, Maternal Age, Minority Groups, Obesity, Maternal, Odds Ratio, Parity, Patient Compliance, Pregnancy, Prenatal Care, Risk Factors, Social Class, Ultrasonography, Prenatal, United Kingdom

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Diabet Med

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Cancer Research UK (21464)
Diabetes UK (17/0005712)
Wellcome Trust (105602/Z/14/Z)
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).