Gestational diabetes mellitus: Clinical predictors and long-term risk of developing type 2 diabetes - A retrospective cohort study using survival analysis
Gestational diabetes mellitus: Clinical predictors and long-term risk of developing type 2 diabetes - A retrospective cohort study using survival analysis
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DOI：
10.2337/dc06-1816
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发表时间：
2007-04-01
期刊：
影响因子：
16.2
通讯作者：
Permezel, Michael
中科院分区：
文献类型：
--
作者：
Lee, Anna J.;Hiscock, Richard J.;Permezel, Michael
目的 - 我们试图确定妊娠合并妊娠糖尿病 (GDM) 后患 2 型糖尿病的长期风险，并评估母亲产前、产后和新生儿因素可预测以后发生 2 型糖尿病。 研究设计和方法 - 这是一项回顾性队列研究，对 5,470 名 GDM 患者和 783 名对照受试者进行生存分析。 1971 年至 2003 年间，Mercy 妇女医院进行产后随访。结果 - 两组患者患糖尿病的风险均随着随访时间的延长而增加，其中 GDM 患者的风险增加了 9.6 倍。 GDM 患者诊断后 15 年患 2 型糖尿病的累积风险为 25.8%。发生 2 型糖尿病的预测因素包括胰岛素的使用（风险比 3.5）、亚洲血统与白种人相比（2.1）以及 1 小时血糖（每增加 1 mmol 超过 10.1 mmol，血糖升高 1.3）。 BMI 与罹患 2 型糖尿病的风险增加相关，但不符合使用 Cox 比例风险进行有效推断所需的比例风险假设。结论 - 虽然可以在妊娠期中确定后期发展为 2 型糖尿病的特定预测因素，但有 GDM 病史的女性作为一个群体，值得长期随访，以降低她们的过度心血管风险。
OBJECTIVE - We sought to determine the long-term risk of type 2 diabetes following a pregnancy complicated by gestational diabetes mellitus (GDM) and assess what maternal antepartum, postpartum, and neonatal factors are predictive of later development of type 2 diabetes.RESEARCH DESIGN AND METHODS - This was a retrospective cohort study using survival analysis on 5,470 GDM patients and 783 control subjects who presented for postnatal follow-up at the Mercy Hospital for Women between 1971 and 2003.RESULTS - Risk of developing diabetes increased with time of follow-up for both groups and was 9.6 times greater for patients with GDM. The cumulative risk of developing type 2 diabetes for the GDM patients was 25.8% at 15 years postdiagnosis. Predictive factors for the development of type 2 diabetes were use of insulin (hazard ratio 3.5), Asian origin compared with Caucasian (2.1), and 1-h blood glucose (1.3 for every 1 mmol increase above 10.1 mmol). BMI was associated with an increased risk of developing type 2 diabetes but did not meet the assumption of proportional hazards required for valid inference when using Cox proportional hazards.CONCLUSIONS - While specific predictive factors for the later development of type 2 diabetes can be identified in the index pregnancy, women with a history of GDM, as a group, are worthy of long-term follow-up to ameliorate their excess cardiovascular risk.