Implementation of Inpatient 2 Hour Glucose Tolerance Test in the Immediate Postpartum Period

Background

Individuals with gestational diabetes mellitus (GDM) have a markedly increased lifetime risk of type 2 diabetes (T2DM), with up to 30% meeting criteria for prediabetes in the early postpartum period (Bauer et al. 2023). Despite recommendation for postpartum screening, completion rates remain low nationwide at less than 50%, and less than 30% at our institution. As insulin sensitivity rapidly normalizes after delivery, the immediate postpartum period offers a practical and convenient opportunity for screening.

Objective

To develop and implement a standardized inpatient postpartum 2-hour glucose tolerance test (2h GTT) toolkit to improve diabetes screening rates and facilitate timely follow-up care and standardize patient education.

Study Design

We conducted a quality improvement initiative at George Washington University Hospital’s Labor and Delivery and Postpartum Units implementing an EMR-integrated 2h GTT toolkit for patients with GDM. The toolkit included a standardized orderset (glucose load, timed laboratory draws, and nursing instructions), patient-centered educational materials, and staff training. A referral algorithm guided outpatient follow-up based on results.

Results

From June 2025 to March 2026, 76 of 1,323 deliveries (5.7%) were complicated by GDM. Among eligible patients, 44 (57.9%) completed the inpatient 2h GTT. The majority of patients who accepted inpatient screening were insured by medicaid (56.8%). Of all patients screened, 20 (45.5%) had at least one abnormal value and were referred to primary care or endocrinology per protocol.

Conclusion

Implementation of an inpatient postpartum 2h GTT toolkit is feasible and improves screening uptake. This approach facilitates early identification of patients at high risk for T2DM and supports timely intervention during a critical postpartum period.