Endocrine Abstracts

Introduction: It is postulated that uptake rates for gestational diabetes mellitus (GDM) screening would be improved if offered in a setting more accessible to the patient. However, this has not been previously investigated, nor has the feasibility or the acceptability of such an alternative. The aim of this study is to evaluate the rate of uptake of GDM screening in the primary vs secondary care setting, and to qualitatively explore the providers’ experience of primary care screening provision.

Methods: This mixed methods study was composed of a quantitative unblinded parallel group randomised controlled trial and qualitative interview trial. 781 pregnant women were randomised to receive a 2-h, 75 g oral glucose tolerance test in either the primary (n=391) or secondary care (n=390) setting. Semi-structured interviews with 13 primary care providers were conducted.

Results: Statistically significant differences were noted between the two quantitative study arms for uptake rates (52.7% in primary care compared to 89.2% in secondary care; P<0.001), crossover rates (32.5% in primary care compared to 2.3% in secondary care; P<0.001), and non-uptake rates (14.8% in primary care compared to 8.5% in secondary care; P=0.005). Of the total potential participants, 37.2% (n=1206) could not be involved as their primary care provider did not engage with the trial. Primary care providers reported difficulties with the conductance of GDM screening citing workload, logistical challenges and lack of remuneration as problematic, while recognising primary care as the most appropriate and preferable location for screening.

Conclusions: Currently, provision of GDM screening in primary care in Ireland, despite its acknowledged benefits, is unfeasible due to poor uptake rates, poor rates of primary care provider engagement and primary care provider concerns, particularly with regard to resourcing limitations.

Disclosure: This work was supported by the Health Research Board of Ireland (grant number ICE/2011/3).