Patient Preferences for Automated Reminders Following Gestational Diabetes

Gestational diabetes mellitus (GDM), the onset or recognition of carbohydrate intolerance in pregnancy, affects approximately 3% of non-aboriginal pregnant women in Canada. Although the focus on detection and treatment of GDM has been on obstetrical outcomes, the high risk of development of type 2 diabetes in women identified with GDM may be the most important population health reason for screening in pregnancy. Most expert committees including the Canadian Diabetes Association (CDA) recommend screening for type 2 diabetes in all women who have had GDM 6 weeks to 6 months postpartum with an oral glucose tolerance test (OGTT) as the preferred screening test (1). Using a fasting plasma glucose alone as the screening test for type 2 diabetes postpartum will miss approximately one-third of type 2 diabetes in women with previous GDM and not allow for detection of impaired glucose tolerance (IGT), a strong predictor of cardiovascular disease and progression to type 2 diabetes. Detecting IGT permits implementation of interventions designed to delay or prevent diabetes, such as dietary counselling, exercise and weight management. Despite increased public awareness of the risk of future type 2 diabetes following a pregnancy affected by GDM, screening rates postpartum in this patient population remain suboptimal (2). In our randomized control trial of 223 women, implementation of a reminder letter sent to the patient and primary care provider resulted in a significant increase in screeningwith anOGTT from14% (no reminder) to 61%, within 12 months postpartum (3). When implemented into routine clinical practice the screening rates remainedhigher (28%vs.14%;noreminder),within thefirst6months postpartum (4). The importance of reminders was highlighted in the CDA practice guidelines implementation strategy, Protecting Mothers and Children (http://diabetes.ca/for-professionals/cpg/ protecting-mothers-and-children). The explosion of technology has opened new ways of communicating with patients. In 2009, there were 22.8 million Canadian wireless phone subscribers who sent 1.22 million text messages per day (source: Canadian Wireless Telecommunications Association, Inc). In 2009, 80% of Canadians used the internet and 54% of 18to 35-year-old Canadians used the internet at least a few