Diabetes’ social determinants: What they mean in our practices

August 4, 2017|Ob.Gyn. News

Facilitate access

The ability to attend frequent appointments and to juggle the logistics of transportation, child care, and time off work (all part of the burden of disease management) is a social determinant of health. It’s something we should ask about, and it is often something we can positively impact by modifying our practice hours and/or using telehealth or mobile health techniques.

We should also view access from a long-term perspective. No women should walk away from a pregnancy with gestational or pregestational diabetes without a plan for her continued care. For one, women with gestational diabetes must undergo postpartum glucose testing and must be attentive to their increased lifetime risks of developing type 2 diabetes. Women who already have type 2 diabetes also need ongoing medical care to control their disease postpartum. In addition, the risks of obesity – a condition that so often occurs with diabetes in pregnancy and predisposes women to earlier heart attacks, strokes, and other health problems – need to be monitored and hopefully mitigated.

Coordinating newborn and pediatric care with the mother’s subsequent primary care is optimal. Women often prioritize their babies’ health over their own health and they rarely miss pediatric appointments. Coordinating care through medical homes or other mechanisms may help women remain engaged and may lessen the gaps between obstetrical and subsequent primary care.

For me, facilitating doctor-to-doctor transitions sometimes entails picking up the phone or sending communication to a primary care doctor to say, for instance, “I’m worried about my patient’s lifetime risk of type 2 diabetes, and I’d like to hand off her care to you.” This is one of many small but meaningful steps we can take.

Dr. Yee is an assistant professor in the division of maternal-fetal medicine at Northwestern University, Chicago. She reported having no relevant financial disclosures.