Ep. 8 The REAL barriers to screening for type 2 diabetes after GDM

If you've ever wondered why so many mums who've had GDM don't get tested after birth, or why engaging with ongoing care feels so hard — this episode is for you. And the answer isn't what most people assume.

It's not a lack of caring. It's not laziness. The barriers are real, they are well-documented in the research, and they are specific to this season of life in a way that is important to understand.

In this episode, Jaimee — credentialled diabetes educator, registered nurse, and nurse practitioner (in progress) — walks through the five barriers she sees most consistently in her clinical work and in the literature on post-GDM care.

What we cover in this episode:

1. The system doesn't follow up The postpartum testing recommendations after GDM are clear — a glucose tolerance test at six to twelve weeks, and annual testing ongoing. But in practice, the handover between obstetric and primary care is often incomplete, and women are sent home without an explicit plan. When the system doesn't follow up, women don't know to follow up on themselves.

2. The fog of new motherhood A fasting glucose tolerance test requires nothing to eat or drink from the night before, a trip to pathology, and two hours of sitting and waiting — often with a baby in tow. Research consistently shows postpartum testing rates after GDM are well below fifty percent, and logistics and competing demands are among the most commonly cited reasons. It's not apathy. It's capacity.

3. "It was just a pregnancy thing" If no one has explicitly told a woman otherwise, it is completely reasonable for her to conclude that her risk ended when her pregnancy did. This is a health literacy and communication barrier — and it sits with the system, not the individual.

4. Putting themselves last There is something that happens to many women when they become mothers. Their own health moves to the bottom of the list — not because they don't value it, but because everyone else's needs feel more immediate. In this episode, Jaimee gently challenges the idea that your health can wait — and explains why your metabolic health and your family's wellbeing are not as separate as they might feel right now.

5. Cost and access Some of the most useful testing after GDM — including fasting insulin to assess insulin resistance — is not Medicare rebatable in Australia. Continuous glucose monitoring remains an out-of-pocket expense for most women after GDM. Programs that offer personalised support often cost money. This barrier is real, it is inequitable, and it deserves to be named plainly.

Who this episode is for: Mums who've had GDM who have found themselves putting their own health on the backburner. Women who weren't sure why follow-up felt so hard. Healthcare providers who want to better understand why their patients aren't coming back for testing.

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General education only — speak with your healthcare provider about what's right for you

Whether you're newly postpartum, years past your GDM diagnosis, or supporting someone who's been through this experience, this podcast is for you. Let's create healthy futures together!

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Transcript

0:01

Welcome back to Healthy Futures After GDM. I'm Jamie, credential diabetes educator, registered nurse, and almost there as a nurse practitioner. If you've been following along, last episode we talked about the silence of pre-diabetes and type 2 diabetes. If you haven't had a listen, it's just about eight to nine minutes. I keep them short because I know mums are busy, so hopefully you can have a listen in the car or while you're doing something around the house. Now we talked about how women can feel completely fine, but their metabolic health can quietly be changing in the background. So today I want to dig into some of the things that I see a lot in my clinical work, and that's the barriers. Now, why don't women follow up after gestational diabetes and get tested? Well, let's talk about why busy mums don't get tested after gestational diabetes and why they might not engage in follow-up care or programs designed to help them. And I want to be really clear before I start, this is not about blame, this is not about women not caring, the barriers are real. I came into this during my master's study for my nurse practitioner and have read lots and lots of articles, and all around the world the barriers are similar for mums after gestational diabetes. So let's talk about them. Barrier one is sometimes the system doesn't follow up in a way that reaches busy and tired mums. The first barrier isn't about women at all, it's more about the system. After gestational diabetes, the recommendation is that women have a glucose tolerance test six to twelve weeks postpartum, and then ongoing testing, usually annually, but sometimes it might even say every one to three years. I have already expressed my I guess concerns around that because so much can change in three years with the lifetime risk of type 2 diabetes. I think annually would be a better way to do it. That way you can track what your glucose levels and your HBA1C, that three-month average, are actually doing and take action prior to getting a diagnosis of type 2 diabetes. That's the ideal situation. So, what actually happens in practice? The obstetric doctor is done once baby arrives. The GP may or may not have received a clear handover about the follow-up needs of women after gestational diabetes, and the women herself might be sent home without any real clear communication around what comes next metabolically and health-wise for her and even children. So possibly no referral, maybe a reminder once a year that you could easily miss, and you might not have someone saying in six weeks, here's exactly what you need to do. And when the system doesn't follow up, many women don't follow up on themselves. This is a barrier of the system, it's not a personal failing. Now, one of the other barriers that comes up in the research and when I speak to women on a you know daily basis is just the fog of new motherhood. Even if a woman does know she should get tested, actually doing this is an entirely different thing. Think about what the next six to twelve weeks after baby actually look like. Sleep deprivation, it's hard to describe unless you've actually lived it or possibly still living it. Your feeding Bub, whether that's breastfeeding or formula, and it's just relentless. You may have other children, you're keeping a small human alive and you're trying to keep yourself going at the same time. The idea of organizing a fasting blood test, which means you eat or drink nothing overnight and ideally get eight hours of solid sleep, getting yourself and possibly a baby to the pathology clinic, sitting there for possibly two hours if it is a glucose tolerance test rather than just a fasting glucose test. That's a significant logistical ask in that season of life. And it's a lot to ask of new mums. Now, this is backed by research. Studies consistently show that postpartum testing rates for women after GDM are very low, often well below 50%. And that's why I have created this support network for women after GDM. The logistics and the competing demands are real. Now, another one of the big barriers that I touched on last episode was that gestational diabetes is just a pregnancy thing. If a woman believes that her gestational diabetes resolved when her pregnancy ended, which is the completely reasonable conclusion to reach if no one's told you otherwise, then there's no perceived reason to keep getting tested. Or you might have heard that you have an increased risk but don't truly understand what that means, what that looks like, and how the progression of that can silently be ticking away in the background. And the risk feels like it belonged to the pregnancy and the risk is over. But that's actually not true. This is a health literacy and communication barrier. It sits again within the system, within the handover, and how gestational diabetes is explained and framed at diagnosis and beyond. And I've tried to change the way I talk about it when I do let women know in the education when they do get diagnosed with gestational diabetes. And that's not to create fear, it's more just to start creating that education and that I guess communication around the increased risk, but also just letting her know everything you learn during the pregnancy can be used moving forward to reduce your risk of future type 2 diabetes for both yourself and your family. So women deserve to know what this means for their future, for their children's future, in plain language and having support from both other women who have been through gestational diabetes, but also healthcare professionals. So dietitian and credential diabetes educator in our Facebook group and myself are passionate about trying to get this message and this information out. There's something that happens to women when they become mothers, and that is that their own health moves to the bottom of the list. I can relate to that, and I'm sure every mother listening is the same. It's not because we don't value our health, it's because we have so many other people whose needs feel more immediate, and they probably are. The baby needs feeding, the toddler needs food, drop-off at daycare. If you do the daycare thing, you might have baby and little children at home. Then you've got school age children as well. And your partner probably working, needs support. The house needs, well, it's always needs something, whether it's cleaning, tiding, you know, toilet paper, you're always doing something. There's always something on your mind. Now, in that environment, booking a blood test is probably the last thing on your mind. And I say that as my youngest is due for an immunisation that I'm struggling to book in. So if my children have priorities over myself, that is going to be put to the end of my list if I need something. Making time for yourself for a health appointment, engaging with a program, it can feel self-indulgent. It can feel like something that you'll get to eventually when things settle down. Things don't settle down for years to come. And I'm sure you're very aware of that. The season changes, the follow-up gets delayed, and the wider that gap becomes. And your health is not separate from your family's well-being, it's central to it. The family relies on mum. So please try and prioritize if you haven't had your follow-up. And if you want some more information, please join our private Facebook group and we'd be very happy to help point you in the right direction. I want to name this one last thing plainly because it's real and it is inequitable. Some of the testing and programs that are most useful after gestational diabetes are not fully covered by Medicare. Fasting insulin levels is a little bit of a grey area in this space, and it's needed to calculate how your body is working at a metabolic level. So in the lead up to type 2 diabetes, your body's actually pumping out a whole lot of extra insulin and it is constantly changing. So that's why there is a little bit of inconsistency around the benefits of this test, the fasting insulin and the fasting glucose level. But I can tell you now, if we did a fasting insulin level and it is extremely high or even more elevated than the ideal, then your pancreas is working harder, and that's a red flag that you're heading towards pre-diabetes and gestational diabetes, and we want to act before you get a fasting glucose test that's elevated because this precedes a fasted elevated glucose level. That's something we'll talk more about in the private Facebook group. Continuous glucose monitoring can provide incredibly valuable information if you have someone that's helping you interpret the data, someone that's helped you understand what you need to record when you use these devices. They're a significant investment in your health. So if you do choose to use one, you do want to make sure you've got someone that can help you get the best out of that information and that data. I would encourage you to explore that option if you absolutely cannot get to pathology for your blood tests. It's an out-of-pocket expense, but if you do choose to do it, it's important you have the team or a healthcare professional behind you to help. So programs that offer personalized support cost money, and for many women, particularly those who have just had a baby, they might be on parental leave or managing one income. Cost is a genuine barrier, it's not an excuse. So we need to be honest about that. A system that doesn't always provide follow-up, that reaches new mums, the very real demands of motherhood, a belief that the risk ended after pregnancy, and just that deeply human tendency for mothers to put themselves last, as well as cost and access. None of these are about women not caring or mums not caring. All of them are things we can work on individually and as a healthcare system. So next episode we're going to flip this around and we're going to talk about the facilitators, the things that actually help women engage with their health after gestational diabetes. Because the barriers are real, but so are the pathways through them. If this resonated with you, please hit follow on your favourite podcast app. It does help other women find us. It would mean the world to myself and Tash. And if you have a couple of minutes to share this with a mum who might need to hear it, we would greatly appreciate that as well. You'll find us on Instagram and Facebook. There's a link in the show notes to our private Facebook group if you would like to join us in there. And just remember you matter not just as a mum but as a person. See you in the next episode.