Diagnosis and Treatment of Gestational Diabetes Mellitus: A National Survey of Physician Practices

Aims: We aimed to identify changes in United States practice patterns in gestational diabetes mellitus (GDM) diagnosis and treatment following publication of the 2008 Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study that supported transition toward a 2-hour oral glucose tolerance test. Methods: A total of 1,030 U.S. obstetric providers were surveyed in 2021 about GDM screening, diagnosis, and treatment, as well as perceptions surrounding preparation for the 1-hour, 50-g glucose loading test (GLT). Data were compared with data from a similar 2003 survey. The study was reviewed by the Institutional Review Board at Stanford University and was determined to be exempt. Results: Of 1,030 providers surveyed, 304 (30%) responded. Most respondents continued using the two-step screening method (95.0% versus 95.2% in 2003, p = 0.18). Fewer providers used insulin as a first-line medication (64.1% in 2021 versus 82.3% in 2003, p < 0.001). However, providers practicing for 0-10 years often used insulin as first-line compared with providers practicing for over 10 years (79% versus 55%, p < 0.001). Of 2021 respondents, 39.3% believed that fasting before the 1-hour GLT lowers the glucose result, 34.3% believed it increases the result, and 26.4% believed it would have no effect. Conclusions: Despite data from the HAPO trial, the majority of providers surveyed still use the two-step method for GDM screening. There is wide variability in perceptions and counseling regarding preparation for the 1-hour GLT.