Gestational Diabetes Screening - Decreasing barriers to the two-step glucose tolerance testing
Files
Publication Date
4-29-2026
Keywords
oregon, oregon gme, milwaukie, milwaukie oaa
Disciplines
Endocrinology, Diabetes, and Metabolism | Medical Education | Nephrology
Abstract
Background: Gestational diabetes mellitus (GDM) screening is recommended between 24–28 weeks of gestation to allow timely diagnosis and treatment and reduce adverse maternal and neonatal outcomes. The two-step glucose tolerance testing method is supported by ACOG, though completion can be delayed due to the need for multiple tests. In 2024 at Providence Milwaukie Family Medicine Clinic, incomplete GDM screening occurred in 23.1% of patients, and incomplete two-step screening occurred in 33.3%, with an average completion time of 12 days. Objective: To increase completion rates of two-step GDM screening and reduce time between abnormal 1-hour and diagnostic 3-hour glucose tolerance tests by offering clinic-based testing instead of lab-only screening. Methods: Clinic-based screening was implemented by obtaining supplies and establishing a workflow. Outcomes were evaluated through chart review and data collection. Results: Prior to implementation, the two-step screening completion rate was 70%, with an average completion time of 15 days. From March 2025 to February 2026, completion increased to 81%, with 72.7% completed in clinic and 9% in the lab. Non-completion decreased to 18%. Average completion time improved to 11 days. Conclusion: GDM affects approximately 1 in 11 pregnancies in the United States and can lead to significant maternal and neonatal complications if untreated. Clinic-based screening modestly improved completion rates and reduced time to diagnostic testing. Patients reported the clinic option as convenient. Expanding clinic-based screening may improve access, patient satisfaction, and timely diagnosis, particularly in settings with limited laboratory access. Larger studies are needed to assess statistical significance and long-term obstetric and neonatal outcomes.
Area of Special Interest
Kidney & Diabetes
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Endocrinology
Specialty/Research Institute
Nephrology
