Gestational diabetes: A triage model of care for rural perinatal providers, , ,

OBJECTIVE: Our purpose was to develop a protocol for surveillance, diagnosis, and management of diet-controlled gestational diabetes for rural care providers. STUDY DESIGN: Protocols for medical, nutritional, educational, and psychosocial education and treatment were developed. A diabetes educator, registered dietitian, and social worker provided protocol training on-site to rural providers. Data were collected on maternal-fetal outcome, birth weight, and provider time specific for diabetes. A control group had multidisciplinary care according to California Diabetes and Pregnancy Program protocols. RESULTS: No significant difference in outcome between 39 protocol patients and 48 controls was noted except in time spent for diabetes care. The pilot providers averaged 4.3 hours and control providers 5.6 hours. CONCLUSIONS: With appropriate protocols, rural providers can successfully treat diet-controlled gestational diabetes without a multidisciplinary team. This could extend the outreach of California Diabetes and Pregnancy Programs and potentially reduce costs. (Am J Obstet Gynecol 1996;174:1719-24.)