Progression to type 2 diabetes mellitus and associated risk factors after hyperglycemia first detected in pregnancy: A cross-sectional study in Cape Town, South Africa
Progression to type 2 diabetes mellitus and associated risk factors after hyperglycemia first detected in pregnancy: A cross-sectional study in Cape Town, South Africa
复制标题
DOI：
10.1371/journal.pmed.1002865
复制
发表时间：
2019-09-01
期刊：
影响因子：
15.8
通讯作者：
Levitt, Naomi S.
中科院分区：
文献类型：
--
作者：
Chivese, Tawanda;Norris, Shane A.;Levitt, Naomi S.
研究背景全球数据显示，首次在妊娠期间发现高血糖史(HFDP)的妇女，其进展为2型糖尿病(T2 DM)的风险是那些怀孕时未合并高血糖的妇女的7倍。然而，没有来自撒哈拉以南非洲地区的数据，该地区的糖尿病患病率预计上升幅度在全球最高。这项研究的目的是确定南非开普敦HFDP后5至6年内进展为T2 DM的妇女的比例及其相关的危险因素。方法和结果：在开普敦一家大型转诊医院，所有患有HFDP的妇女在5到6年后进行了横断面研究。每个参与者都接受了75g口服葡萄糖耐量测试；进行了人体测量和调查。共有220名参与者接受了跟踪调查。此时，他们的平均年龄为37.2岁(SD 6.0)。48%(95%可信区间41.2~54.4)进展为T2 DM，5.5%(95%可信区间3.1~9.4)空腹血糖受损，10.5%(95%可信区间7.0~15.3)糖耐量受损。在进展到T2 DM的参与者中，47%的人不知道他们的糖尿病状况。根据世界卫生组织2013年指南对HFDP进行事后分类时，妊娠期糖尿病(DIP)组的进展为81%(95%可信区间70.2-89.0)，妊娠期糖尿病(GDM)类别的进展为31.3%(95%可信区间24.4-39.3)。与进展为T2 DM的风险相关的因素有：在随访时：腰围(OR1.1，95%CI1.0-1.1，p=0.007)，臀围(OR0.9，95%CI0.8-1.0，p=0.001)，体重指数(OR1.1，95%CI1.0-1.3，p=0.001)，基线：胰岛素(OR25.8，95%CI3.9-171.4，p=0.001)和口服降糖治疗(OR4.1，95%CI1.3-12.9，p=0.018)、空腹(OR2.7，95%CI1.5-4.8，p=0.001)和口服葡萄糖耐量试验诊断HFDP时的2小时血糖浓度(OR4.3，95%CI2.4-7.7，p<；0.001)。我们的发现有局限性，因为我们没有包括没有HFDP病史的对照组妇女。结论本研究发现既往有HFDP病史的妇女进展为T2 DM，这凸显了干预措施的必要性，以延缓或预防HFDP后进展为T2 DM。此外，预防HFDP的干预措施也可能有助于降低T2 DM的风险。作者摘要：为什么要进行这项研究？国际研究表明，当一名妇女在怀孕期间检测到糖尿病，怀孕后可能会消失，她未来患糖尿病的风险仍然很高。然而，我们不知道非洲女性进展为2型糖尿病的比例是多少，因为尽管糖尿病患者数量迅速增加，但之前没有进行过任何研究。研究人员做了什么并发现了什么？我们在南非开普敦召回了220名在怀孕期间首次发现糖尿病的女性，并对她们进行了2型糖尿病测试。我们发现，在随访中，几乎一半的女性(48%)患有2型糖尿病。在患有2型糖尿病的女性中，47%的人不知道自己患有2型糖尿病。我们还发现，在随访时肥胖，以及在妇女接受妊娠期糖尿病(DIP)测试时血糖浓度较高，会增加怀孕5至6年后进展为2型糖尿病的机会。这些发现意味着什么？在怀孕期间首次发现糖尿病的南非妇女中，有很大一部分可能在早年和怀孕后6年内患上2型糖尿病。可能有必要在怀孕后改变他们的生活方式，这样他们就可以减少发展为2型糖尿病的机会。怀孕后需要更频繁地进行2型糖尿病筛查，以便患糖尿病的妇女得到更早的诊断和治疗。需要进一步的研究，因为我们没有将妊娠期血糖正常的妇女纳入这项研究。
Background Global data indicate that women with a history of hyperglycemia first detected in pregnancy (HFDP) are at up to 7 times risk of progressing to type 2 diabetes mellitus (T2DM) compared with their counterparts who have pregnancies that are not complicated by hyperglycemia. However, there are no data from the sub-Saharan African region, which has the highest projected rise in diabetes prevalence globally. The aim of this study was to determine the proportion of women who progress to T2DM and associated risk factors 5 to 6 years after HFDP in Cape Town, South Africa. Methods and findings All women with HFDP, at a major referral hospital in Cape Town, were followed up 5 to 6 years later using a cross-sectional study. Each participant had a 75 g oral glucose tolerance test; anthropometric measurements and a survey were administered. A total of 220 participants were followed up. At this time, their mean age was 37.2 years (SD 6.0). Forty-eight percent (95% CI 41.2-54.4) progressed to T2DM, 5.5% (95% CI 3.1-9.4) had impaired fasting glucose, and 10.5% (95% CI 7.0-15.3) had impaired glucose tolerance. Of the participants who progressed to T2DM, 47% were unaware of their diabetes status. When HFDP was categorized post hoc according to WHO 2013 guidelines, progression in the diabetes in pregnancy (DIP) group was 81% (95% CI 70.2-89.0) and 31.3% (95% CI 24.4-39.3) in the gestational diabetes mellitus (GDM) category. Factors associated with risk of progression to T2DM were; at follow-up: waist circumference (odds ratios [OR] 1.1, 95% CI 1.0-1.1, p = 0.007), hip circumference (OR 0.9, 95% CI 0.8-1.0, p = 0.001), and BMI (OR 1.1, 95% CI 1.0-1.3, p = 0.001), and at baseline: insulin (OR 25.8, 95% CI 3.9-171.4, p = 0.001) and oral hypoglycaemic treatment during HFDP (OR 4.1, 95% CI 1.3-12.9, p = 0.018), fasting (OR 2.7, 95% CI 1.5-4.8, p = 0.001), and oral glucose tolerance test 2-hour glucose concentration at HFDP diagnosis (OR 4.3, 95% CI 2.4-7.7, p < 0.001). Our findings have limitations in that we did not include a control group of women without a history of HFDP. Conclusions The progression to T2DM in women with previous HFDP found in this study highlights the need for interventions to delay or prevent progression to T2DM after HFDP. In addition, interventions to prevent HFDP may also contribute to reducing the risk of T2DM.Author summaryWhy was this study done? International research shows that when a woman has diabetes detected in pregnancy, which may resolve after the pregnancy, she remains at high risk of future diabetes. However, we do not know what proportion of women progress to type 2 diabetes in Africa, because there is no research that has been done before, despite the rapid increase in the number of people with diabetes. What did the researchers do and find? We recalled 220 women 5 to 6 years after they had diabetes first detected in pregnancy and tested them for type 2 diabetes in Cape Town, South Africa. We found that almost half of the women (48%) at follow up had type 2 diabetes. Of the women with type 2 diabetes, 47% did not know that they had type 2 diabetes. We also found that being obese at follow-up and having higher blood glucose concentrations at the time the women were tested for diabetes in pregnancy (DIP) increased the chances of progressing to type 2 diabetes 5 to 6 years after the pregnancy. What do these findings mean? A large proportion of South African women who have diabetes first detected in pregnancy may develop type 2 diabetes at an early age and within 6 years after the pregnancy. It may be necessary to change their lifestyle after the pregnancy so they can reduce the chance of progressing to type 2 diabetes. Screening for type 2 diabetes after the pregnancy needs to be more often so women who develop diabetes are diagnosed and receive treatment earlier. Further research is needed, because we did not include women with normal blood glucose during pregnancy in this study.