There are approximately 7 million pregnancies across the United States and Europe every year1. Of these, more than 1 million women develop gestational diabetes (GDM). For every one of those women, international standards of care recommend follow-up testing with an oral glucose tolerance test (OGTT) at 6 to 12 weeks post-partum, with further testing at 12 months and beyond.
In theory, around 1 million women per year should receive structured post-partum diabetes screening. In practice, however, this is not the case.
The long-term risks are well established. In the UK 50% of women who have had GDM develop type 2 diabetes within five years and in countries with higher overall diabetes prevalence rates things can be worse. In real terms, this translates in Europe and the USA to around 2.6 million women developing type 2 diabetes within five years of a GDM-affected pregnancy. In addition, around 6% of women with prior GDM may develop type 1 diabetes2.
These numbers represent the women who have been diagnosed with GDM. Several studies agree though that potentially over half of the women affected by GDM do not even know they had the condition3. As a result, they are unaware of their future diabetes risk and do not attend post-partum screening. That means many are living with undetected post-partum type 2 diabetes and their children carry increased risk of diabetes also.
Even among women with known GDM, follow-up rates are strikingly low. In both the UK and USA, post-partum test uptake is often below 20%. In the UK, only 4.5% of women with prior GDM engage with diabetes prevention programmes - meaning 95.5% are effectively lost to follow-up4.
Compounding the problem is the use of HbA1c as a substitute for OGTT in some settings. The sensitivity of HbA1c in the post-partum period is typically only 20% to 30% at best. The International Diabetes Federation (IDF) advises against using HbA1c for detecting hyperglycaemia because of its low sensitivity. In short, in addition to false negative GDM diagnoses and low post-partum testing uptake - many cases are simply missed due to suboptimal testing method.
This is where GTT@home offers a transformative opportunity. Post-partum is an intense and unpredictable period. New mothers are recovering physically, adjusting emotionally, managing feeding schedules, sleep deprivation, and sometimes caring for other children. Asking them to attend a hospital appointment that requires fasting, travelling, sitting in a clinic for two hours, and arranging childcare creates a very real barrier - not a lack of motivation, but a lack of time, flexibility, and headspace. The rigidity of the in-clinic OGTT simply does not align with the realities of life with a newborn.
Real-world screening for GDM using GTT@home has demonstrated uptake rate of at least 96%, with 92% of patients rating the home test 4 or 5 out of 5. The test is both sensitive and specific, eliminating false negative GDM screens and ensuring that more at-risk women are identified for appropriate post-partum follow-up. While we don’t have data on GTT@home post-partum uptake, it can be expected to be higher than the current post-partum uptake.
GTT@home allows women to complete their test at a day and time that suits them, when a partner or family member is available to care for the baby during the two-hour window. By fitting around real life rather than disrupting it, GTT@home removes practical and psychological barriers, making follow-up screening far more achievable and therefore far more likely to happen. Whilst legacy in-clinic OGTT is widely reported as a loathed experience, the overwhelmingly positive experience provided by GTT@home should make it easier to achieve higher rates of post-partum testing. Furthermore, women tested for GDM using GTT@home can be embraced by Digostics’ support structures, ensuring women are not lost to follow-up if they need post-partum testing.
In Europe and the USA, with over one million women per year requiring follow-up, post-partum screening represents one of the largest untapped opportunities in diabetes prevention. Integrating home-based OGTT into routine maternity care could make a major impact on the growing epidemic of GDM-related type 2 diabetes - and ensure that far fewer women fall through the cracks at the most critical moment for prevention.
1https://www.figo.org/FIGO-globaldeclaration-hip
2https://pubmed.ncbi.nlm.nih.gov/32725280/
3https://onlinelibrary.wiley.com/doi/10.1111/dme.15476