Gestational Diabetes Mellitus: A Study of Women Who Fail to Attend Appointments

One of the challenges clinicians face in managing patients with diabetes is to ensure that patients comply with their therapy. Patients may lack motivation to adhere to recommendations from diabetologists, diabetes nurse educators, and dietitians, and their attendance to clinic appointments can be erratic. A recent study demonstrated that clinic nonattendance and noncompliance to therapy were both independent predictors of mortality for patients with type 2 diabetes.1 Women with gestational diabetes mellitus (GDM) are usually informed by their obstetrics or diabetes team (at their first educational session) that suboptimal glycemic control could affect the well-being of their developing fetuses, and this may provide greater motivation for them to adhere to therapy. In addition to antenatal visits, women with GDM must attend education sessions on GDM management, and they require regular follow-up with their diabetes team until delivery. To date, there is little information in the literature addressing compliance issues for women with GDM. Because optimal GDM management has been shown to affect pregnancy outcomes for women with GDM, we hypothesized that nonattendance to diabetes-related appointments may have adverse effects on the pregnancy outcomes of women with GDM. In this study, we assessed the attendance of diabetes-related appointments for women with GDM and explored clinical factors that were associated with failure-to-attend (FTA) rates for these women in a single public hospital in the southwestern part of Sydney, Australia. We also evaluated the pregnancy outcomes of women with GDM who had failed to attend two or more of their diabetes appointments during pregnancy. A retrospective review was conducted on all pregnant women who were diagnosed with GDM and who had received diabetes education at the Diabetes Centre at Liverpool Hospital between 1 January and 31 December 2011. Demographic data, including age, parity, BMI, ethnicity, family history of diabetes, history of previous …