Cabizuca C A, Rocha P S, Marques J V, Costa T F L R, Santos A S N, Schröder A L, Mello C A G, Sousa H D, Silva E S G, Braga F O, Abi-Abib R C, Gomes M B
Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
Rua Cinco de Julho 63/504 Copacabana, Rio de Janeiro, CEP 22051-030 Brazil.
Diabetol Metab Syndr. 2018 Jan 3;10:2. doi: 10.1186/s13098-017-0303-4. eCollection 2018.
Gestational diabetes is a risk factor for future development of type 2 diabetes. The primary aim of this study was to estimate the prevalence of postpartum glucose tolerance status evaluation in pregnancies complicated by gestational diabetes 6-12 weeks after delivery. The secondary one was to identify the factors that are implicated with postpartum glucose retesting.
This was a retrospective study performed with a cohort of women with gestational diabetes, with prenatal care and delivery at a tertiary care center, from January 2013 to April 2017. The diagnosis of gestational diabetes was based on IADPSG criteria (Fasting ≥ 92 mg/dl, 1 h ≥ 180 mg/dl and/or 2 h ≥ 153 mg/dl, respectively) and the diagnosis of type 2 diabetes and prediabetes were made using the 2016 ADA's criteria (fasting and 2 h after glucose load ≥ 126 mg/dl and/or ≥ 200 and 100-125 mg/dl and/or 140 and 199 mg/dl, respectively). All women had an appointment scheduled 6-12 weeks postpartum with the results of a 75-g oral glucose tolerance test (OGTT).
Of the 152 evaluated women, 21 (13.8%) returned with the postpartum OGTT results. Of these, 9 (45.0%) had a diagnosis of prediabetes. The use of insulin during gestation was the only factor implicated in a higher adherence rate to postpartum testing OR 6.33 (p 0.002). No significance was found for other demographic and clinical variables (age, family income, years of study, parity, gestational age at first visit, smoking, family history of type 2 diabetes, diagnosis of gestational diabetes before the third trimester, pregestational body mass index, previous history of gestational diabetes and ethnicity).
The majority of patients with gestational diabetes did not return postpartum to perform OGTT and in our study the only factor implicated in a higher postpartum return was the use of insulin during pregnancy. Considering that 45.0% were diagnosed with prediabetes, diabetes care teams should initially identify non-adherent patients.
妊娠期糖尿病是未来发生2型糖尿病的一个危险因素。本研究的主要目的是评估产后6 - 12周时，患有妊娠期糖尿病的孕妇产后糖耐量状态评估的患病率。次要目的是确定与产后血糖复测相关的因素。
这是一项回顾性研究，研究对象为2013年1月至2017年4月在一家三级医疗中心接受产前护理和分娩的妊娠期糖尿病女性队列。妊娠期糖尿病的诊断基于国际糖尿病与妊娠研究组（IADPSG）标准（空腹血糖≥92mg/dl、1小时血糖≥180mg/dl和/或2小时血糖≥153mg/dl），2型糖尿病和糖尿病前期的诊断采用2016年美国糖尿病协会（ADA）标准（空腹血糖和葡萄糖负荷后2小时血糖分别≥126mg/dl和/或≥200mg/dl以及100 - 125mg/dl和/或140mg/dl和199mg/dl）。所有女性在产后6 - 12周预约了75克口服葡萄糖耐量试验（OGTT）的检查。
在152名接受评估的女性中，21名（13.8%）返回了产后OGTT结果。其中，9名（45.0%）被诊断为糖尿病前期。孕期使用胰岛素是与产后检查更高依从率相关的唯一因素，比值比为6.33（p = 0.002）。在其他人口统计学和临床变量（年龄、家庭收入、受教育年限、产次、首次就诊时的孕周、吸烟、2型糖尿病家族史、孕晚期前妊娠期糖尿病的诊断、孕前体重指数、既往妊娠期糖尿病史和种族）方面未发现显著差异。
大多数妊娠期糖尿病患者产后未返回进行OGTT检查，在我们的研究中，与产后更高返回率相关的唯一因素是孕期使用胰岛素。鉴于45.0%的患者被诊断为糖尿病前期，糖尿病护理团队应首先识别不依从的患者。
