Conversion of gestational diabetes mellitus to future Type 2 diabetes mellitus and the predictive value of HbA1c in an Indian cohort
Conversion of gestational diabetes mellitus to future Type 2 diabetes mellitus and the predictive value of HbA1c in an Indian cohort
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DOI：
10.1111/dme.13102
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发表时间：
2017-01-01
影响因子：
3.5
通讯作者：
Tandon, N.
中科院分区：
文献类型：
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作者：
Gupta, Y.;Kapoor, D.;Tandon, N.
目的调查印度既往妊娠糖尿病女性中血糖异常（2 型糖尿病和糖尿病前期）的分布和危险因素。方法邀请来自新德里和海得拉巴两个产科单位的有妊娠糖尿病病史的所有女性 (n = 989) 参加，其中 366 名 (37%) 同意。收集社会人口学、医学和人体测量数据，并进行75克口服葡萄糖耐量试验。结果在被诊断患有妊娠糖尿病的怀孕5年内（中位14个月）内，263名（72％）女性出现血糖异常，其中分别有119名（32％）和144名（40％）患有2型糖尿病和糖尿病前期。较高的 BMI [比值比为 1.16 每 1-kg/m(2) 更大的 BMI (95% CI 1.10, 1.28)]、存在黑棘皮病 [比值比 3.10, 95% CI (1.64, 5.87)]、产后筛查间隔 [比值比为每 1 个月更大的筛查间隔 1.02 95% CI (1.01, 1.04)] 和年龄 [年龄每大 1 岁，比值比 1.10 95% CI (1.04, 1.16)] 患血糖异常的可能性较高。美国糖尿病协会推荐的 HbA(1c) 阈值为 48 mmol/mol (6.5%)，确定产后是否存在 2 型糖尿病的敏感性和特异性分别为 81.4% 和 90.7%。 结论 本研究报告的妊娠后糖尿病向糖尿病的高妊娠后转化率强化了强制产后筛查和确定预防发展为 2 型糖尿病的策略的必要性。使用美国糖尿病协会推荐的糖尿病 HbA(1c) 阈值可能会导致严重的漏诊。最新消息？这项研究提供了有关有妊娠期糖尿病病史的印度女性患 2 型糖尿病风险的新信息。患有妊娠糖尿病的女性在怀孕 5 年内，32% 的女性会发展为 2 型糖尿病。另外 40% 患有糖尿病前期。 2 型糖尿病的患病率在 2 年内从 < 25% 上升到 2-4 年随访后的近 50%。首次根据印度样本评估了 HbA(1c) 在产后筛查中的效用。 HbA(1c) 48 mmol/mol (6.5%) 对于确定产后是否存在 2 型糖尿病的敏感性和特异性分别为 81% 和 91%。提供了与血糖异常风险增加相关的因素的详细分析。
AimTo investigate the distribution of and risk factors for dysglycaemia (Type 2 diabetes and prediabetes) in women with previous gestational diabetes mellitus in India.MethodsAll women (n = 989) from two obstetric units in New Delhi and Hyderabad with a history of gestational diabetes were invited to participate, of whom 366 (37%) agreed. Sociodemographic, medical and anthropometric data were collected and 75-g oral glucose tolerance test were carried out.ResultsWithin 5 years (median 14 months) of the pregnancy in which they were diagnosed with gestational diabetes, 263 (72%) women were dysglycaemic, including 119 (32%) and 144 (40%) with Type 2 diabetes and prediabetes, respectively. A higher BMI [odds ratio 1.16 per 1-kg/m(2) greater BMI (95% CI 1.10, 1.28)], presence of acanthosis nigricans [odds ratio 3.10, 95% CI (1.64, 5.87)], postpartum screening interval [odds ratio 1.02 per 1 month greater screening interval 95% CI (1.01, 1.04)] and age [odds ratio 1.10 per 1-year older age 95% CI (1.04, 1.16)] had a higher likelihood of having dysglycaemia. The American Diabetes Association-recommended threshold HbA(1c) value of 48 mmol/mol (6.5%) had a sensitivity and specificity of 81.4 and 90.7%, respectively, for determining the presence of Type 2 diabetes postpartum.ConclusionThe high post-pregnancy conversion rates of gestational diabetes to diabetes reported in the present study reinforce the need for mandatory postpartum screening and identification of strategies for preventing progression to Type 2 diabetes. Use of the American Diabetes Association-recommended HbA(1c) threshold for diabetes may lead to significant under-diagnosis.What's new?This study provides new information pertaining to the risk of developing Type 2 diabetes among Indian women with a history of gestational diabetes mellitus. Within 5 years of a gestational diabetes pregnancy, 32% women have progressed to Type 2 diabetes. Another 40% have prediabetes. The prevalence of Type 2 diabetes rose from < 25% within 2 years to almost 50% after 2-4 years' follow-up. The utility of HbA(1c) in postpartum screening has been evaluated for the first time from an Indian sample. HbA(1c) 48 mmol/mol (6.5%) had a sensitivity and specificity of 81 and 91%, respectively, for determining the presence of Type 2 diabetes postpartum. A detailed analysis of factors associated with increased risk of dysglycaemia is provided.