Conversion of gestational diabetes mellitus to future Type 2 diabetes mellitus and the predictive value of HbA 1c in an Indian cohort.

Publisher: Blackwell Science Country of Publication: England NLM ID: 8500858 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1464-5491 (Electronic) Linking ISSN: 07423071 NLM ISO Abbreviation: Diabet Med Subsets: MEDLINE

Publication: Oxford : Blackwell Science
Original Publication: Chichester [Sussex, England] ; New York : Wiley, [c1984-

Diabetes Mellitus, Type 2/*etiology ; Diabetes, Gestational/*physiopathology ; Glucose Intolerance/*etiology ; Glycated Hemoglobin/*analysis ; Prediabetic State/*etiology; Adult ; Cohort Studies ; Diabetes Mellitus, Type 2/diagnosis ; Diabetes Mellitus, Type 2/epidemiology ; Diabetes Mellitus, Type 2/ethnology ; Diabetes, Gestational/blood ; Diabetes, Gestational/ethnology ; Disease Progression ; Female ; Follow-Up Studies ; Glucose Intolerance/diagnosis ; Glucose Intolerance/epidemiology ; Glucose Intolerance/ethnology ; Glucose Tolerance Test ; Humans ; India/epidemiology ; Postpartum Period ; Prediabetic State/diagnosis ; Prediabetic State/epidemiology ; Prediabetic State/ethnology ; Predictive Value of Tests ; Pregnancy ; Prevalence ; Prospective Studies ; Risk Factors ; Sensitivity and Specificity

Aim: To investigate the distribution of and risk factors for dysglycaemia (Type 2 diabetes and prediabetes) in women with previous gestational diabetes mellitus in India.
Methods: All 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.
Results: Within 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.
Conclusion: The 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.
(© 2016 Diabetes UK.)

0 (Glycated Hemoglobin A)
0 (hemoglobin A1c protein, human)

Date Created: 20160302 Date Completed: 20180220 Latest Revision: 20221207

20240628

10.1111/dme.13102

26926329