Boston University School of Public Health, United States; Boston University School of Medicine, United States.
Boston University School of Public Health, United States.
Prev Med. 2018 Aug;113:1-6. doi: 10.1016/j.ypmed.2018.05.005. Epub 2018 May 8.
This study investigates the effect of severity of gestational diabetes (GDM) on likelihood of post-delivery glucose testing and early onset Type 2 diabetes (T2DM). We asked if clinical focus on relative risk (RR), i.e. greater probability of T2DM onset in a higher-severity group, contributes to missed opportunities for prevention among women with lower-severity GDM. A sample of 12,622 continuously-insured women with GDM (2006-2015) was drawn from a large national dataset (OptumLabs® Data Warehouse) and followed for 3-years post-delivery. Higher-severity GDM was defined as addition of hypoglycemic therapy to standard of care for GDM. We found that women with higher-severity (n = 2627) were twice as likely as lower-severity women (n = 9995) to obtain glucose testing post-delivery. Moreover, 357 (13.6%) of the higher-severity women developed T2DM by year-3 vs. 600 (6.0%) lower-severity women. In an analysis of the population attributable fraction (PAF), defined as the contribution of excess risk to population prevalence, lower-severity women contributed more cases to diabetes rates than higher-risk women (PAF 79% vs. 21%), despite an increased RR in the higher-severity group (13.6% vs. 6.0%, RR 2.26, 95%CI 2.00, 2.56). Projecting out to the 327,950 U.S. deliveries in 2014, we estimate that 9277 higher-severity women (13.6%) and 15,584 lower-severity women (6.0%), will have developed T2DM by 2018. These data demonstrate that lower-severity GDM contributes substantially to the diabetes epidemic. Greater awareness of clinical and cost implications of gaps in follow-up for lower-severity GDM may strengthen the likelihood of post-delivery testing and primary care referral, and thus reinforce the path to prevention.
本研究旨在探讨妊娠期糖尿病（GDM）严重程度对产后血糖检测和早发 2 型糖尿病（T2DM）的影响。我们想知道，临床是否关注相对风险（RR），即高严重度组 T2DM 发病的可能性更大，是否会导致低严重度 GDM 患者错失预防机会。我们从一个大型国家数据库（OptumLabs®Data Warehouse）中抽取了 12622 名连续投保的 GDM 女性（2006-2015 年）作为样本，对她们进行了产后 3 年的随访。高严重度 GDM 定义为在 GDM 的标准治疗基础上添加降糖治疗。我们发现，高严重度 GDM 组（n=2627）产后进行血糖检测的可能性是低严重度 GDM 组（n=9995）的两倍。此外，高严重度 GDM 组中 357 名（13.6%）女性在第 3 年发展为 T2DM，而低严重度 GDM 组中 600 名（6.0%）女性发展为 T2DM。在人群归因分数（PAF）分析中，PAF 定义为风险增加对人群患病率的贡献，低严重度 GDM 女性对糖尿病发病率的贡献大于高风险女性（PAF 79% vs. 21%），尽管高严重度 GDM 组的 RR 更高（13.6% vs. 6.0%，RR 2.26，95%CI 2.00，2.56）。根据 2014 年美国 327950 例分娩推算，我们估计到 2018 年，将有 9277 例高严重度 GDM 女性（13.6%）和 15584 例低严重度 GDM 女性（6.0%）发展为 T2DM。这些数据表明，低严重度 GDM 对糖尿病流行做出了重要贡献。提高对低严重度 GDM 随访差距的临床和成本影响的认识，可能会增加产后检测和初级保健转诊的可能性，从而强化预防途径。
