Gupta Y, Kapoor D, Desai A, Praveen D, Joshi R, Rozati R, Bhatla N, Prabhakaran D, Reddy P, Patel A, Tandon N
Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India.
Centre for Chronic Disease Control, Gurgaon, India.
Diabet Med. 2017 Jan;34(1):37-43. doi: 10.1111/dme.13102. Epub 2016 Mar 17.
To investigate the distribution of and risk factors for dysglycaemia (Type 2 diabetes and prediabetes) in women with previous gestational diabetes mellitus in India.
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.
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 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 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.
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 threshold for diabetes may lead to significant under-diagnosis.
调查印度既往有妊娠期糖尿病的女性血糖异常（2型糖尿病和糖尿病前期）的分布情况及危险因素。
邀请了新德里和海得拉巴两个产科单位有妊娠期糖尿病史的所有女性（n = 989）参与，其中366名（37%）同意参加。收集了社会人口统计学、医学和人体测量学数据，并进行了75克口服葡萄糖耐量试验。
在被诊断为妊娠期糖尿病的妊娠后5年内（中位时间14个月），263名（72%）女性存在血糖异常，其中分别有119名（32%）和144名（40%）患有2型糖尿病和糖尿病前期。较高的体重指数[体重指数每增加1 kg/m²的比值比为1.16（95%可信区间1.10，1.28）]、黑棘皮症的存在[比值比3.10，95%可信区间（1.64，5.87）]、产后筛查间隔[筛查间隔每增加1个月的比值比为1.02，95%可信区间（1.01，1.04）]和年龄[年龄每增加1岁的比值比为1.10，95%可信区间（1.04，1.16）]发生血糖异常的可能性更高。美国糖尿病协会推荐的糖化血红蛋白（HbA）值≥48 mmol/mol（6.5%）用于确定产后2型糖尿病存在时的敏感性和特异性分别为81.4%和90.7%。
本研究报告的妊娠期糖尿病产后向糖尿病的高转化率强化了产后进行强制性筛查以及确定预防进展为2型糖尿病策略的必要性。使用美国糖尿病协会推荐的糖尿病HbA阈值可能会导致大量漏诊。
