Gestational diabetes - Major problems with post-partum testing.

BACKGROUND: Post-partum follow up testing of women with gestational diabetes mellitus (GDM) is important. All women, and their family doctors, receive written reminders. There are no recent major Australian reviews of the efficacy and compliance with this advice conducted in an ethnically representative population and using the current diagnostic criteria. AIM: The aim was to examine a cohort of women with recently diagnosed GDM and a completed pregnancy to determine what proportion had been tested and what were the difficulties in having testing carried out. METHODS: Women who were diagnosed with gestational diabetes and attended the Diabetes Service in 2017 were followed up in 2019. Attempted contact was made using an unidentified land line, an identifiable mobile phone and a postal survey. Compliance with testing advice was the major parameter considered. RESULTS: There were 714 women with GDM, 75 were excluded: 64 after pass one and 11 after pass two. In total, only 339/639 (53.1%) could be contacted. Of these women, 334 agreed to be surveyed; 207 (62.0%) had a post-partum test. Of the 127 women who had not had a test, 113 agreed to have an HbA1c. Only 13/113 (11.5%) had this done within a month. CONCLUSION: Contacting women, even within a short time after the pregnancy, is difficult. The number of post-partum tests carried out is suboptimal. Written advice to all women and their doctors does not appear to be working. A review of the cost effectiveness of this approach and development of new methods may be worthwhile.

Key Characteristics of Public Health Interventions Aimed at Increasing Whole Grain Intake: A Systematic Review.

OBJECTIVE: To identify characteristics of successful public health interventions aimed at increasing whole grain consumption. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-analyses framework, guided by higher-quality interventions with greatest effect size, was adopted to conduct a systematic literature review. RESULTS: Of 8,500 initial records, only 8 interventions with demonstrated reach (up to national populations) and effectiveness (increasing consumption 8-27 g/d) were eligible for synthesis. Their characteristics included multiple stakeholder involvement, specified target intakes in dietary guidelines, manufacturer codes of practice, product reformulation, evidence-based educational resources, social media, and community events with tasting and preparation opportunities. Empowerment of food service providers was also linked to success. CONCLUSIONS AND IMPLICATIONS: Successful interventions require multifaceted strategies across multiple aspects of the food system, underpinned by multiple stakeholder partnerships. Uniform capture of interventions using an online, searchable, public domain resource may provide a strategy to enable health professionals globally to plan local interventions across cultural settings, drawing on best practice guidelines developed from interventions with demonstrated reach and effectiveness.