(182) Postpartum Diabetes Medication Titration Protocol: Effect on Inpatient Efficiency and Glycemic Management Outcomes

Insulin resistance declines postpartum, necessitating timely medication adjustments in those with diabetes. On our Labor & Delivery (L&D) unit, medication regimen decision-making was delaying transfer to postpartum (PP). In response, we implemented a protocol to calculate postpartum medication regimens among patients with pre-existing diabetes during the antepartum period. Our objective was to evaluate if the protocol improved efficient PP patient transfer and improved inpatient and outpatient diabetes outcomes.

Study Design:

            This was a pre-post quality improvement study at a tertiary-care academic hospital. The study included all delivering patients with pre-existing diabetes separated into two cohorts pre- (Feb 2023-Feb 2024) and post- (Apr 2024-April 2025) protocol implementation. The primary outcome was delayed PP transfer, defined as post-delivery time on L&D > 1 standard deviation above the mean ( > 3.66 hours based on institution-specific transfer time of 2.9 +/- 0.76 hours). Outcomes were compared between the cohorts using bivariate analyses and logistic regression.

Results:

            There were 124 patients in each cohort and 31% had type 1 diabetes. The post-implementation cohort had decreased odds of delayed PP transfer compared to pre- implementation after adjusting for insulin pump use, hypertensive disorders of pregnancy, and postpartum hemorrhage (aOR 0.50 [0.26-0.95]). This decrease in delayed PP transfer was not seen when stratified by diabetes type (Table 1). There was a higher rate of documented PP medication plans and outpatient postpartum glycemic control review in the post-implementation cohort (Table 2). There were no differences in inpatient postpartum hyper- or hypoglycemia or postpartum endocrinology or primary care follow up.

Conclusion:

            Enacting a postpartum diabetes medication protocol facilitated more efficient PP transfers and improved PP glycemic control follow up, while not increasing rates of inpatient postpartum hyper- or hypoglycemia. This serves as a model to improve L&D efficiency at other high acuity tertiary care centers.