Diabetes Unit, Massachusetts General Hospital, Boston, MA.
Department of Medicine, Massachusetts General Hospital, Boston, MA.
Diabetes Care. 2023 Jan 1;46(1):83-91. doi: 10.2337/dc22-1390.
Pregnant individuals are universally screened for gestational diabetes mellitus (GDM). Gestational glucose intolerance (GGI) (an abnormal initial GDM screening test without a GDM diagnosis) is not a recognized diabetes risk factor. We tested for an association between GGI and diabetes after pregnancy.
We conducted a retrospective cohort study of individuals followed for prenatal and primary care. We defined GGI as an abnormal screening glucose-loading test result at ≥24 weeks' gestation with an oral glucose tolerance test (OGTT) that did not meet GDM criteria. The primary outcome was incident diabetes. We used Cox proportional hazards models with time-varying exposures and covariates to compare incident diabetes risk in individuals with GGI and normal glucose tolerance.
Among 16,836 individuals, there were 20,359 pregnancies with normal glucose tolerance, 2,943 with GGI, and 909 with GDM. Over a median of 8.4 years of follow-up, 428 individuals developed diabetes. Individuals with GGI had increased diabetes risk compared to those with normal glucose tolerance in pregnancy (adjusted hazard ratio [aHR] 2.01 [95% CI 1.54-2.62], P < 0.001). Diabetes risk increased with the number of abnormal OGTT values (zero, aHR 1.54 [1.09-2.16], P = 0.01; one, aHR 2.97 [2.07-4.27], P < 0.001; GDM, aHR 8.26 [6.49-10.51], P < 0.001 for each compared with normal glucose tolerance). The fraction of cases of diabetes 10 years after delivery attributable to GGI and GDM was 8.5% and 28.1%, respectively.
GGI confers an increased risk of future diabetes. Routinely available clinical data identify an unrecognized group who may benefit from enhanced diabetes screening and prevention.
普遍对孕妇进行妊娠期糖尿病（GDM）筛查。妊娠期葡萄糖不耐受（GGI）（初始 GDM 筛查异常但未诊断为 GDM）并非公认的糖尿病危险因素。我们检测了 GGI 与妊娠后糖尿病之间的关联。
我们对接受产前和初级保健的个体进行了回顾性队列研究。我们将 GGI 定义为妊娠 24 周后负荷试验葡萄糖异常，口服葡萄糖耐量试验（OGTT）不符合 GDM 标准。主要结局是新发糖尿病。我们使用具有时变暴露和协变量的 Cox 比例风险模型比较 GGI 个体和正常葡萄糖耐量个体的新发糖尿病风险。
在 16836 名个体中，有 20359 例正常葡萄糖耐量妊娠，2943 例 GGI，909 例 GDM。中位随访 8.4 年后，428 人发生糖尿病。与正常葡萄糖耐量妊娠相比，GGI 个体发生糖尿病的风险增加（校正风险比 [aHR] 2.01 [95% CI 1.54-2.62]，P < 0.001）。糖尿病风险随异常 OGTT 值的数量增加而增加（零值，aHR 1.54 [1.09-2.16]，P = 0.01；1 个，aHR 2.97 [2.07-4.27]，P < 0.001；GDM，aHR 8.26 [6.49-10.51]，与正常葡萄糖耐量相比，P < 0.001）。产后 10 年糖尿病归因于 GGI 和 GDM 的比例分别为 8.5%和 28.1%。
GGI 增加了未来发生糖尿病的风险。常规可用的临床数据确定了一个未被认识到的群体，他们可能受益于增强的糖尿病筛查和预防。
