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Provider factors from the proposed conceptual model that might affect ordering of a postpartum diabetes test were not readily available. Additional mediating factors that are not accessible in EHR or claims data e. Insufficient sample size may have precluded detection of additional important predictors of postpartum diabetes screening. Further, obesity could not be incorporated in the model because weight data were missing on a substantial proportion of the population, and obesity is undercoded in administrative claims.
Although previous birth in the data set was used as a proxy for parity, women without a previous birth in this data set could have had a delivery prior to Diabetes education with a non-certified provider could not be captured as only billed prenatal visits with a CDE were included.
Although utilizing administrative codes to identify comorbidities, complications, and some laboratory tests may be a limitation, many of these codes have been validated in prior studies. Despite its limitations, this study highlights key points relevant to Medicaid policy that should be explored further. First, it emphasizes the importance of improving Medicaid reimbursement for diabetes education and enhancing access to diabetes education in resource-limited settings. Prospective studies should evaluate novel models that integrate prenatal diabetes education and postpartum support into FQHC settings to improve postpartum diabetes screening.
Future exploration comparing postpartum diabetes screening rates in Medicaid expansion states and non-expansion states is warranted, though this will likely be challenging. Fragmented healthcare data systems in the U. However, because this is the first study linking EHR and Medicaid data to study this transition of care, it highlights a need to improve the interoperability and communication of national data systems to improve capacity for enhanced chronic disease prevention and management.
Finally, the majority of women with GDM on Medicaid during pregnancy are not being screened postpartum. In summary, achieving guideline-recommended screening in support of diabetes prevention among high-risk women will require a comprehensive multidisciplinary approach with continued study of local interventions, systems change, and state and national policy initiatives.
The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH. The funding sources had no role in the study design, data collection, management, analysis, interpretation of the data, or manuscript preparation. CJH conceived of the study, provided clinical expertise, worked with MAO and MRK in data management to define the final population, conducted data analysis, and wrote the manuscript.
MRK conducted all data management activities to refine the final population, developed the healthcare utilization and screening variables, and edited the manuscript. AMT conducted the geographic information systems analysis and edited the manuscript.
BPC worked with CJH to develop the study design and data request plan and work with collaborators to develop data use agreements. He provided mentorship in the use of electronic health record data and edited the manuscript.
MAO provided administrative data analysis expertise, oversaw data management and analysis, and edited the manuscript. GAC made substantial contributions to study conception and design, data analysis and interpretation, and manuscript revision. CJH takes full responsibility for the content of this manuscript.
All authors have read and approved the manuscript and agree to be accountable for their contributions and the accuracy and integrity of the work. Preliminary analyses for this manuscript were previously presented as a poster at the American Diabetes Association meeting on June 7—11, in San Francisco, CA. BPC was previously employed by the Centene Corporation. Deliveries were identified in the time frame for 5, of these women.
Am J Prev Med. Author manuscript; available in PMC Feb 1. Cynthia J. Keller , MS, 3 Anne M. Louis, Missouri Find articles by Cynthia J. Matthew R.
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Euclid Avenue, Campus Box , St. Louis MO Copyright notice. The publisher's final edited version of this article is available at Am J Prev Med. Abstract Introduction: Women with gestational diabetes are 7 times more likely to develop type 2 diabetes and require lifelong diabetes screening. Methods: Electronic health record and Medicaid claims data were linked to generate a retrospective cohort of 1, women with gestational diabetes receiving care in Federally Qualified Health Centers in Missouri from to Conclusions: This study underscores the importance of access to public transportation, prenatal diabetes education, and continued healthcare coverage for women on Medicaid to support receipt of guideline-recommended follow-up care and improve health equity.
Open in a separate window. Figure 1. Measures The primary outcome was receipt of the first recommended diabetes screening test during the 18 months after delivery of the GDM pregnancy. Table 1. Table 2. Appendix Table 1. Variable Definitions Utilizing Administrative Codes. Each insulin name encompasses all variations of that brand. Each oral medication encompasses different formulations including extended release and combination therapy and includes only classes typically prescribed in pregnancy.
Prev Chronic Dis. Gestational diabetes in the United States: temporal changes in prevalence rates between and Prevalence of gestational diabetes and subsequent type 2 diabetes among U. Diabetes Res Clin Pract. Gestational diabetes and the incidence of type 2 diabetes: a systematic review.
Diabetes Care. Racial and ethnic disparities in diabetes risk after gestational diabetes mellitus. Committee on Practice Bulletin-Obstetrics. Obstet Gynecol. American Diabetes Association. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions.
J Clin Endocrinol Metab. The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: the Diabetes Prevention Program Outcomes Study 10 year follow-up. Kaiser Family Foundation. Births Financed by Medicaid. Accessed September 16, Trends in Medicaid Income Eligibility.
Accessed September 21, Economic costs attributable to diabetes in each U. J Womens Health Larchmt. Postpartum screening for diabetes among Medicaid-eligible South Carolina women with gestational diabetes. Womens Health Issues. Utilization of primary and obstetric care after medically complicated pregnancies: an analysis of medical claims data.
J Gen Intern Med. Postpartum diabetes screening among low income women with gestational diabetes in Missouri — BMC Public Health. Postpartum screening for diabetes among women with a history of gestational diabetes mellitus. Trends in postpartum diabetes screening and subsequent diabetes and impaired fasting glucose among women with histories of gestational diabetes mellitus: a report from the Translating Research Into Action for Diabetes TRIAD Study. Prevalence and timing of postpartum glucose testing and sustained glucose dysregulation after gestational diabetes mellitus.
Variation in postpartum glycemic screening in women with a history of gestational diabetes mellitus. Bandura A Social foundations of thought and action: a social cognitive theory. Bandura A Health promotion by social cognitive means. Determine the most efficient and effective methods for engaging and keeping members in the Raising Well Pediatric Obesity program to help the family members change and reach health goals.
Conduct a randomized controlled trial to study the impact of a basic needs navigation intervention on health behaviors and outcomes in a diabetic population in Louisiana. Collect insights from Medicaid members to inform the design and content of a new online goal-setting platform. Search our comprehensive library for more research and information about our focus areas and many more topics geared toward improving the lives in our communities.
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WebIn type 1 diabetes, the body does not produce insulin. The body breaks down the carbohydrates you eat into blood glucose (blood sugar) that it uses for energy—and insulin is a hormone that the body needs to get glucose from the . WebSep 16, · Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. WebDiabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from .