Prevention of Diabetes in Women with a History of Gestational Diabetes: Effects of Metformin and Lifestyle Interventions
Prevention of Diabetes in Women with a History of Gestational Diabetes: Effects of Metformin and Lifestyle Interventions
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DOI：
10.1210/jc.2008-0772
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发表时间：
2008-12-01
影响因子：
5.8
通讯作者：
Kahn, Steven E.
中科院分区：
文献类型：
--
作者：
Ratner, Robert E.;Christophi, Costas A.;Kahn, Steven E.
内容：妊娠期糖尿病（GDM）的过去的历史赋予一个非常高的风险，产后发展的糖尿病，特别是2型diabetes.Objective：糖尿病预防计划（DPP）试图确定个人与糖耐量减低（IGT）和干预，努力防止或延缓其进展为糖尿病。这项分析研究了有和没有GDM.Design的报告历史的DPP登记的妇女之间的差异：DPP是一项随机对照的临床试验。设置：这项研究是一项多中心，国立卫生研究院赞助的试验，在27个中心进行，包括学术和印度卫生服务网站。患者：共有2190名妇女被随机分配到DPP组，并提供了GDM既往史的信息。这项分析探讨了350名有GDM既往史的妇女和1416名有活产史但无GDM病史的妇女之间的差异。干预措施：受试者随机接受标准生活方式和安慰剂或二甲双胍治疗或强化生活方式干预。主要结局：主要结果是通过半年空腹血糖和每年口服葡萄糖耐量试验确定的糖尿病发展时间。胰岛素分泌和胰岛素敏感性的评估也performed.Results：而进入研究类似的葡萄糖水平，女性GDM随机安慰剂的历史有一个粗的糖尿病发病率71%高于妇女没有这样的历史。在报告有GDM病史的女性中，与安慰剂组相比，强化生活方式和二甲双胍治疗均使糖尿病发病率降低约50%，而在无GDM的经产女性中，这一降低分别为49%和14%。这些数据表明，二甲双胍可能是更有效的妇女与GDM的历史相比，那些没有.Conclusions：进展为糖尿病更常见的妇女与GDM的历史相比，那些没有GDM的历史，尽管同等程度的IGT在基线。强化的生活方式和二甲双胍在延缓或预防IGT和GDM病史的女性糖尿病方面都非常有效。（临床内分泌代谢杂志93：4774-4779，2008）
Context: A past history of gestational diabetes mellitus (GDM) confers a very high risk of postpartum development of diabetes, particularly type 2 diabetes.Objective: The Diabetes Prevention Program (DPP) sought to identify individuals with impaired glucose tolerance (IGT) and intervene in an effort to prevent or delay their progression to diabetes. This analysis examined the differences between women enrolled in DPP with and without a reported history of GDM.Design: The DPP was a randomized, controlled clinical trial.Setting: The study was a multicenter, National Institutes of Health-sponsored trial carried out at 27 centers including academic and Indian Health Services sites.Patients: A total of 2190 women were randomized into the DPP and provided information for past history of GDM. This analysis addressed the differences between those 350 women providing a past history of GDM and those 1416 women with a previous live birth but no history of GDM.Interventions: Subjects were randomized to either standard lifestyle and placebo or metformin therapy or to an intensive lifestyle intervention.Main Outcomes: The primary outcome was the time to development of diabetes ascertained by semiannual fasting plasma glucose and annual oral glucose tolerance testing. Assessments of insulin secretion and insulin sensitivity were also performed.Results: Whereas entering the study with similar glucose levels, women with a history of GDM randomized to placebo had a crude incidence rate of diabetes 71% higher than that of women without such a history. Among women reporting a history of GDM, both intensive lifestyle and metformin therapy reduced the incidence of diabetes by approximately 50% compared with the placebo group, whereas this reduction was 49 and 14%, respectively in parous women without GDM. These data suggest that metformin may be more effective in women with a GDM history as compared with those without.Conclusions: Progression to diabetes is more common in women with a history of GDM compared with those without GDM history despite equivalent degrees of IGT at baseline. Both intensive lifestyle and metformin are highly effective in delaying or preventing diabetes in women with IGT and a history of GDM. (J Clin Endocrinol Metab 93: 4774-4779, 2008)