Incidence Rate of Type 2 Diabetes Mellitus after Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of 170,139 Women
Incidence Rate of Type 2 Diabetes Mellitus after Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of 170,139 Women
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DOI：
10.1155/2020/3076463
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发表时间：
2020-04-28
影响因子：
4.3
通讯作者：
Wang, Zilian
中科院分区：
文献类型：
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作者：
Li, Zhuyu;Cheng, Yunjiu;Wang, Zilian
目标。妊娠期糖尿病(GDM)后发生2型糖尿病(T2 DM)的报道差异很大。这项荟萃分析的目的是确定有妊娠期糖尿病病史的女性中T2 DM的发病率，并检查可能影响该发病率的因素。研究设计与方法。我们在PubMed和Embase上搜索与GDM之后的T2 DM相关的术语，直到2019年1月。纳入样本量为300，随访时间至少为一年的大型队列研究。从选定的研究中提取数据，并使用随机效应模型进行荟萃分析。分组分析基于妊娠期糖尿病的样本大小、地理区域、母亲年龄、体重指数、诊断标准和随访时间。结果。28项研究涉及170,139名妊娠期糖尿病妇女和34,627例T2 DM病例。妊娠期糖尿病合并T2 DM发病率为每1000人年26.20例(95%可信区间为23.31~29.10)。来自亚洲的女性和那些年龄较大、体重指数较高的女性患T2 DM的风险似乎更高。应用IADPSG诊断妊娠期糖尿病的发病率最低，为7.16/1000人年。妊娠期糖尿病后发生T2 DM的风险随随访时间的延长而线性增加。每年随访的增量估计为千分之九点六。T2 DM的风险估计值分别为10年19.72%、20年29.36%、30年39.00%、40年48.64%、50年58.27%。结论。妊娠期糖尿病后T2 DM高发的研究结果为了解T2 DM在产后长期的发展轨迹提供了重要依据，可为咨询提供依据，并可能激励更多的GDM妇女进行T2 DM筛查。该试验的注册编号为PROSPERO识别码CRD42019128980。
Objective. The reported incidence of type 2 diabetes mellitus (T2DM) after gestational diabetes (GDM) varies widely. The purpose of this meta-analysis was to define the incidence rate of T2DM among women with a history of GDM and to examine what might modulate the rate. Research Design and Methods. We searched PubMed and Embase for terms related to T2DM after GDM up to January 2019. Large cohort studies with sample size >= 300 and follow-up duration of at least one year were included. Data from selected studies were extracted, and meta-analysis was performed using the random-effects model. Subgroups analyses were based on the sample size of gestational diabetes, geographic region, maternal age, body-mass index, diagnostic criteria, and duration of follow-up. Results. Twenty-eight studies involving 170,139 women with GDM and 34,627 incident cases of T2DM were identified. The pooled incidence of T2DM after GDM was 26.20 (95% CI, 23.31 to 29.10) per 1000 person-years. Women from Asia and those with older age and higher body mass index seem to experience higher risk of developing T2DM. The incidence rate of T2DM was lowest when applying IADPSG (7.16 per 1000 person-years) to diagnose GDM. The risk of developing T2DM after GDM increased linearly with the duration of follow-up. The increments per year of follow-up were estimated at 9.6 parts per thousand. The estimated risks for T2DM were 19.72% at 10 years, 29.36% at 20 years, 39.00% at 30 years, 48.64% at 40 years, and 58.27% at 50 years, respectively. Conclusions. The findings of very high incidence of T2DM after GDM add an important insight into the trajectory of the development of T2DM in the long-term postpartum periods, which could provide evidence for consultant and might motivate more women with GDM to screen for T2DM. This trial is registered with PROSPERO identifier CRD42019128980.