Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Medicine and Health Sciences, University of Cape Town, Cape Town, South Africa.
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Medicine and Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLoS Med. 2019 Sep 9;16(9):e1002865. doi: 10.1371/journal.pmed.1002865. eCollection 2019 Sep.
Global data indicate that women with a history of hyperglycemia first detected in pregnancy (HFDP) are at up to 7 times risk of progressing to type 2 diabetes mellitus (T2DM) compared with their counterparts who have pregnancies that are not complicated by hyperglycemia. However, there are no data from the sub-Saharan African region, which has the highest projected rise in diabetes prevalence globally. The aim of this study was to determine the proportion of women who progress to T2DM and associated risk factors 5 to 6 years after HFDP in Cape Town, South Africa.
All women with HFDP, at a major referral hospital in Cape Town, were followed up 5 to 6 years later using a cross-sectional study. Each participant had a 75 g oral glucose tolerance test; anthropometric measurements and a survey were administered. A total of 220 participants were followed up. At this time, their mean age was 37.2 years (SD 6.0). Forty-eight percent (95% CI 41.2-54.4) progressed to T2DM, 5.5% (95% CI 3.1-9.4) had impaired fasting glucose, and 10.5% (95% CI 7.0-15.3) had impaired glucose tolerance. Of the participants who progressed to T2DM, 47% were unaware of their diabetes status. When HFDP was categorized post hoc according to WHO 2013 guidelines, progression in the diabetes in pregnancy (DIP) group was 81% (95% CI 70.2-89.0) and 31.3% (95% CI 24.4-39.3) in the gestational diabetes mellitus (GDM) category. Factors associated with risk of progression to T2DM were; at follow-up: waist circumference (odds ratios [OR] 1.1, 95% CI 1.0-1.1, p = 0.007), hip circumference (OR 0.9, 95% CI 0.8-1.0, p = 0.001), and BMI (OR 1.1, 95% CI 1.0-1.3, p = 0.001), and at baseline: insulin (OR 25.8, 95% CI 3.9-171.4, p = 0.001) and oral hypoglycaemic treatment during HFDP (OR 4.1, 95% CI 1.3-12.9, p = 0.018), fasting (OR 2.7, 95% CI 1.5-4.8, p = 0.001), and oral glucose tolerance test 2-hour glucose concentration at HFDP diagnosis (OR 4.3, 95% CI 2.4-7.7, p < 0.001). Our findings have limitations in that we did not include a control group of women without a history of HFDP.
The progression to T2DM in women with previous HFDP found in this study highlights the need for interventions to delay or prevent progression to T2DM after HFDP. In addition, interventions to prevent HFDP may also contribute to reducing the risk of T2DM.
全球数据表明，与血糖正常妊娠相比，有妊娠期间高血糖史（HFDP）的女性进展为 2 型糖尿病（T2DM）的风险高达 7 倍。然而，在撒哈拉以南非洲地区，糖尿病的发病率预计将全球最高，却没有该地区的数据。本研究旨在确定在南非开普敦，HFDP 女性在妊娠后 5 至 6 年内进展为 T2DM 的比例及相关风险因素。
在开普敦的一家主要转诊医院，所有 HFDP 女性在妊娠后 5 至 6 年时通过横断面研究进行了随访。每位参与者均接受了 75 g 口服葡萄糖耐量试验；进行了人体测量学测量和问卷调查。共随访了 220 名参与者。此时，他们的平均年龄为 37.2 岁（标准差 6.0）。48%（95%置信区间 41.2-54.4）进展为 T2DM，5.5%（95%置信区间 3.1-9.4）有空腹血糖受损，10.5%（95%置信区间 7.0-15.3）有糖耐量受损。在进展为 T2DM 的参与者中，47%的人不知道自己的糖尿病状况。根据世卫组织 2013 年指南对 HFDP 进行分类后，在妊娠糖尿病（DIP）组中，糖尿病的进展为 81%（95%置信区间 70.2-89.0），在妊娠期糖尿病（GDM）组中为 31.3%（95%置信区间 24.4-39.3）。与进展为 T2DM 相关的风险因素包括：随访时：腰围（比值比[OR] 1.1，95%置信区间 1.0-1.1，p = 0.007）、臀围（OR 0.9，95%置信区间 0.8-1.0，p = 0.001）和 BMI（OR 1.1，95%置信区间 1.0-1.3，p = 0.001），以及基线时：胰岛素（OR 25.8，95%置信区间 3.9-171.4，p = 0.001）和 HFDP 期间口服降血糖治疗（OR 4.1，95%置信区间 1.3-12.9，p = 0.018）、空腹（OR 2.7，95%置信区间 1.5-4.8，p = 0.001）和口服葡萄糖耐量试验 2 小时时 HFDP 诊断的血糖浓度（OR 4.3，95%置信区间 2.4-7.7，p < 0.001）。我们的研究结果存在一定的局限性，因为我们没有包括没有 HFDP 病史的女性对照组。
本研究发现 HFDP 女性进展为 T2DM，这突出表明需要采取干预措施来延迟或预防 HFDP 后 T2DM 的进展。此外，预防 HFDP 的干预措施也可能有助于降低 T2DM 的风险。
Zotero 插件
