Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland.
Eur J Endocrinol. 2013 Oct 3;169(5):681-7. doi: 10.1530/EJE-13-0491. Print 2013 Nov.
Previous gestational diabetes (GDM) is associated with a significant lifetime risk of type 2 diabetes. In this study, we assessed the performance of HbA1c and fasting plasma glucose (FPG) measurements against that of 75 g oral glucose tolerance testing (OGTT) for the follow-up screening of women with previous GDM.
Two hundred and sixty-six women with previous GDM underwent the follow-up testing (mean of 2.6 years (s.d. 1.0) post-index pregnancy) using HbA1c (100%), and 75 g OGTT (89%) or FPG (11%). American Diabetes Association (ADA) criteria for abnormal glucose tolerance were used.
DESIGN, COHORT STUDY, AND RESULTS: The ADA HbA1c high-risk cut-off of 39 mmol/mol yielded sensitivity of 45% (95% CI 32, 59), specificity of 84% (95% CI 78, 88), negative predictive value (NPV) of 87% (95% CI 82, 91) and positive predictive value (PPV) of 39% (95% CI 27, 52) for detecting abnormal glucose tolerance. ADA high-risk criterion for FPG of 5.6 mmol/l showed sensitivity of 80% (95% CI 66, 89), specificity of 100% (95% CI 98, 100), NPV of 96% (95% CI 92, 98) and PPV of 100% (95% CI 91, 100). Combining HbA1c ≥39 mmol/mol with FPG ≥5.6 mmol/l yielded sensitivity of 90% (95% CI 78, 96), specificity of 84% (95% CI 78, 88), NPV of 97% (95% CI 94, 99) and PPV of 56% (95% CI 45, 66).
Combining test cut-offs of 5.6 mmol/l and HbA1c 39 mmol/mol identifies 90% of women with abnormal glucose tolerance post-GDM (mean 2.6 years (s.d.1.0) post-index pregnancy). Applying this follow-up strategy will reduce the number of OGTT tests required by 70%, will be more convenient for women and their practitioners, and is likely to lead to increased uptake of long-term retesting by these women whose risk for type 2 diabetes is substantially increased.
既往妊娠糖尿病（GDM）与 2 型糖尿病终生发病风险显著相关。本研究旨在评估糖化血红蛋白（HbA1c）和空腹血糖（FPG）检测在随访既往 GDM 女性中的表现，与 75g 口服葡萄糖耐量试验（OGTT）相比。
266 例既往 GDM 女性于指数妊娠后平均 2.6 年（标准差 1.0 年）进行随访检测，检测方法包括 HbA1c（100%）、75g OGTT（89%）或 FPG（11%）。采用美国糖尿病协会（ADA）异常葡萄糖耐量标准。
设计、队列研究及结果：ADA 界值 39mmol/mol 诊断 HbA1c 高风险的敏感度为 45%（95%CI，3259），特异度为 84%（95%CI，7888），阴性预测值（NPV）为 87%（95%CI，8291），阳性预测值（PPV）为 39%（95%CI，2752）。ADA 界值 5.6mmol/L 诊断 FPG 高风险的敏感度为 80%（95%CI，6689），特异度为 100%（95%CI，98100），NPV 为 96%（95%CI，9298），PPV 为 100%（95%CI，91100）。HbA1c≥39mmol/mol 联合 FPG≥5.6mmol/L 可使敏感度达到 90%（95%CI，7896），特异度为 84%（95%CI，7888），NPV 为 97%（95%CI，9499），PPV 为 56%（95%CI，4566）。
5.6mmol/L 和 HbA1c 39mmol/mol 这两个切点联合使用可识别 90%的 GDM 后异常葡萄糖耐量女性（平均随访时间为指数妊娠后 2.6 年（标准差 1.0 年））。采用该随访策略，OGTT 检测量将减少 70%，同时对女性及其医生更方便，可能会增加这些 2 型糖尿病风险显著增加的女性长期重复检测的依从性。
