Division of Endocrinology, Metabolism, Haematological Sciences and Therapeutics, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
Division of Internal Medicine, Yamaguchi Red Cross Hospital, Yamaguchi-City, Yamaguchi, Japan.
Diabet Med. 2018 Aug;35(8):1111-1117. doi: 10.1111/dme.13657. Epub 2018 May 23.
To identify factors predicting early postpartum glucose intolerance in Japanese women with gestational diabetes mellitus, using decision-curve analysis.
A retrospective cohort study was performed. The participants were 123 Japanese women with gestational diabetes who underwent 75-g oral glucose tolerance tests at 8-12 weeks after delivery. They were divided into a glucose intolerance and a normal glucose tolerance group based on postpartum oral glucose tolerance test results. Analysis of the pregnancy oral glucose tolerance test results showed predictive factors for postpartum glucose intolerance. We also evaluated the clinical usefulness of the prediction model based on decision-curve analysis.
Of 123 women, 78 (63.4%) had normoglycaemia and 45 (36.6%) had glucose intolerance. Multivariable logistic regression analysis showed insulinogenic index/fasting immunoreactive insulin and summation of glucose levels, assessed during pregnancy oral glucose tolerance tests (total glucose), to be independent risk factors for postpartum glucose intolerance. Evaluating the regression models, the best discrimination (area under the curve 0.725) was obtained using the basic model (i.e. age, family history of diabetes, BMI ≥25 kg/m and use of insulin during pregnancy) plus insulinogenic index/fasting immunoreactive insulin <1.1. Decision-curve analysis showed that combining insulinogenic index/fasting immunoreactive insulin <1.1 with basic clinical information resulted in superior net benefits for prediction of postpartum glucose intolerance.
Insulinogenic index/fasting immunoreactive insulin calculated using oral glucose tolerance test results during pregnancy is potentially useful for predicting early postpartum glucose intolerance in Japanese women with gestational diabetes.
使用决策曲线分析，确定预测日本妊娠糖尿病女性产后早期葡萄糖不耐受的因素。
进行了一项回顾性队列研究。参与者为 123 名日本妊娠糖尿病女性，她们在产后 8-12 周进行了 75g 口服葡萄糖耐量试验。根据产后口服葡萄糖耐量试验结果，将她们分为葡萄糖耐量异常组和正常葡萄糖耐量组。分析妊娠口服葡萄糖耐量试验结果，找出产后葡萄糖耐量异常的预测因素。我们还基于决策曲线分析评估了预测模型的临床实用性。
123 名女性中，78 名（63.4%）血糖正常，45 名（36.6%）葡萄糖耐量异常。多变量逻辑回归分析显示，妊娠口服葡萄糖耐量试验期间的胰岛素生成指数/空腹免疫反应胰岛素和血糖总和（总葡萄糖）是产后葡萄糖耐量异常的独立危险因素。对回归模型进行评估后，使用基本模型（即年龄、糖尿病家族史、BMI≥25kg/m 和孕期使用胰岛素）加胰岛素生成指数/空腹免疫反应胰岛素<1.1 获得了最佳的区分度（曲线下面积 0.725）。决策曲线分析显示，将胰岛素生成指数/空腹免疫反应胰岛素<1.1 与基本临床信息相结合，对预测妊娠糖尿病女性产后早期葡萄糖耐量异常具有更高的净收益。
使用妊娠口服葡萄糖耐量试验结果计算的胰岛素生成指数/空腹免疫反应胰岛素，可能对预测日本妊娠糖尿病女性产后早期葡萄糖耐量异常有一定作用。
