The Diabetes Care Gap Most Women Never Hear About
Pregnancy Planning Gets the Least Attention
For women with diabetes who are considering pregnancy, preconception counseling is especially important. Blood sugar control before and during pregnancy significantly affects outcomes for both mother and child. Yet the data shows that fertility and prepregnancy counseling rates among women with diabetes were low across studies — and in some cases, as low as 1 percent. There wasn’t enough comparative data to measure the gap against women without diabetes clearly, but the raw numbers alone are striking. Women who go into pregnancy without this counseling miss a window where proactive steps could reduce the risk of complications considerably. The researchers noted this as one of the most concerning findings in the review.
More Doctor Visits Don’t Automatically Mean Better Coverage
One of the counterintuitive aspects of this research is that higher healthcare utilization didn’t protect women from these gaps. Women with diabetes often have more contact with the medical system than their peers — more appointments, more lab work, more specialist involvement. Yet those touchpoints weren’t translating into comprehensive preventive care. As Lauren Wisk, PhD, the study’s senior author and an associate professor at UCLA Health, noted, the issue isn’t frequency of visits. It’s what happens during those visits and whether anyone takes responsibility for the full picture of a patient’s health. A system oriented around one condition can miss everything adjacent to it.
Why Endocrinologists Aren’t Set Up to Fill This Role
Many women with diabetes rely on their endocrinologist as their main point of medical contact. That arrangement makes sense for managing the condition itself — endocrinologists specialize in hormonal and metabolic disorders, and diabetes is a significant one. But as Dr. Marilyn Tan, an endocrinologist at Stanford Health Care, explained, most endocrinology practices are not structured to provide contraception counseling or age-appropriate cancer screening. The visit agenda is built around blood sugar, medications, and related metabolic issues. That focus is appropriate and necessary — but it leaves preventive care in a gap zone where it isn’t clearly anyone’s responsibility.
How the Fragmented Healthcare System Plays a Role
The U.S. healthcare system is not organized around comprehensive, coordinated care for individual patients. It tends to operate in silos — specialists handle their area, primary care handles its area, and the hand-offs between them are inconsistent. For women with diabetes, this fragmentation creates a specific vulnerability. When the specialist is focused on the chronic condition and there’s no primary care physician actively managing the rest of the preventive checklist, things fall through the cracks. Dr. Wisk described it directly: the system isn’t especially good at care coordination, and someone needs to be actively ensuring that preventive services are happening — which doesn’t always occur in practice.