Department of Obstetrics & Gynecology, Baruch Padeh Medical Center Poriya, Tiberias, Israel.
Department of Obstetrics & Gynecology, Emek Medical Center, Afula, Israel.
J Diabetes. 2020 Mar;12(3):205-214. doi: 10.1111/1753-0407.12985. Epub 2019 Oct 30.
To examine possible markers for undiagnosed type 2 diabetes in early-onset gestational diabetes mellitus (GDM).
A population-based retrospective cohort study of women with GDM diagnosed prior to the 24th week, who delivered between 2005 and 2018, was conducted. The results of the 50-g glucose challenge test, 100-g oral glucose tolerance test, and the first available glycosylated hemoglobin (HbA1c) were examined as markers for type 2 diabetes diagnosed 6 to 12 weeks post pregnancy, which is suggestive of pregestational diabetes. This was done by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for each marker. These markers and additional ones were evaluated for independency by stepwise multivariate logistic regression.
Of 69 417 pregnancies, 3321 (5%) pregnancies were with GDM. Of them, in 261 (8%) women GDM was diagnosed prior to the 24th week, and 219 (84%) women had available data for analysis. Among them, 11 (5%) women had type 2 diabetes post pregnancy. Elevated HbA1c was the most accurate marker for undiagnosed type 2 diabetes (AUC 91% with 95% CI [81%-100%]) and the only independent marker for undiagnosed type 2 diabetes in multivariate analysis (odds ratio [OR] 19; 95% CI [3.2-109], C statistic = 88%). Using the ROC curve, a cutoff of 5.8% predicted type 2 diabetes with 89% sensitivity, 86% specificity, 99.4% negative predictive value, and 23% positive predictive value.
Early-onset GDM with HbA1c ≥ 5.8% should be managed as type 2 diabetes. Definitive diagnosis should be done after delivery.
研究早发型妊娠期糖尿病（GDM）中未确诊的 2 型糖尿病的可能标志物。
对 2005 年至 2018 年期间诊断为 24 周前 GDM 的患者进行了一项基于人群的回顾性队列研究。检查了 50g 葡萄糖挑战试验、100g 口服葡萄糖耐量试验和首次可获得的糖化血红蛋白（HbA1c）的结果，作为妊娠后 6 至 12 周诊断的 2 型糖尿病的标志物，提示孕前糖尿病。通过计算每个标志物的受试者工作特征（ROC）曲线下面积（AUC）来实现。通过逐步多变量逻辑回归评估这些标志物和其他标志物的独立性。
在 69417 例妊娠中，有 3321 例（5%）妊娠为 GDM。其中，261 例（8%）妇女在 24 周前被诊断为 GDM，219 例（84%）妇女有可用于分析的数据。其中，11 例（5%）妇女在产后患有 2 型糖尿病。升高的 HbA1c 是未确诊 2 型糖尿病最准确的标志物（AUC 91%，95%CI[81%-100%]），也是多变量分析中唯一独立的未确诊 2 型糖尿病标志物（优势比[OR]19；95%CI[3.2-109]，C 统计量=88%）。使用 ROC 曲线，切点为 5.8%，预测 2 型糖尿病的灵敏度为 89%，特异性为 86%，阴性预测值为 99.4%，阳性预测值为 23%。
HbA1c≥5.8%的早发型 GDM 应作为 2 型糖尿病进行管理。应在分娩后进行明确诊断。
